The contribution of viruses and bacteria to community-acquired pneumonia in vaccinated children: A case - Control study

Mejbah Uddin Bhuiyan, Thomas L. Snelling, Rachel West, Jurissa Lang, Tasmina Rahman, Caitlyn Granland, Camilla De Gier, Meredith L. Borland, Ruth B. Thornton, Lea Ann S. Kirkham, Chisha Sikazwe, Andrew C. Martin, Peter C. Richmond, David W. Smith, Adam Jaffe, Christopher C. Blyth

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Introduction: Respiratory pathogens associated with childhood pneumonia are often detected in the upper respiratory tract of healthy children, making their contribution to pneumonia difficult to determine. We aimed to determine the contribution of common pathogens to pneumonia adjusting for rates of asymptomatic detection to inform future diagnosis, treatment and preventive strategies. Methods: A case-control study was conducted among children <18 years in Perth, Western Australia. Cases were children hospitalised with radiologically confirmed pneumonia; controls were healthy children identified from outpatient and local immunisation clinics. Nasopharyngeal swabs were collected and tested for 14 respiratory viruses and 6 bacterial species by Polymerase chain reaction (PCR). For each pathogen, adjusted odds ratio (aOR; 95% CI) was calculated using multivariate logistic regression and population-attributable fraction (95% CI) for pneumonia was estimated. Results: From May 2015 to October 2017, 230 cases and 230 controls were enrolled. At least one respiratory virus was identified in 57% of cases and 29% of controls (aOR: 4.7; 95% CI: 2.8 to 7.8). At least one bacterial species was detected in 72% of cases and 80% of controls (aOR: 0.7; 95% CI: 0.4 to 1.2). Respiratory syncytial virus (RSV) detection was most strongly associated with pneumonia (aOR: 58.4; 95% CI: 15.6 to 217.5). Mycoplasma pneumoniae was the only bacteria associated with pneumonia (aOR: 14.5; 95% CI: 2.2 to 94.8). We estimated that RSV, human metapneumovirus (HMPV), influenza, adenovirus and Mycoplasma pneumoniae were responsible for 20.2% (95% CI: 14.6 to 25.5), 9.8% (5.6% to 13.7%), 6.2% (2.5% to 9.7%), 4% (1.1% to 7.1%) and 7.2% (3.5% to 10.8%) of hospitalisations for childhood pneumonia, respectively. Conclusions: Respiratory viruses, particularly RSV and HMPV, are major contributors to pneumonia in Australian children.

Original languageEnglish
Pages (from-to)261-269
Number of pages9
JournalThorax
Volume74
Issue number3
Early online date18 Oct 2018
DOIs
Publication statusPublished - Mar 2019

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Case-Control Studies
Pneumonia
Viruses
Bacteria
Respiratory Syncytial Viruses
Metapneumovirus
Mycoplasma pneumoniae
Western Australia
Hospitalized Child
Adenoviridae
Respiratory System
Human Influenza
Immunization
Hospitalization
Outpatients
Logistic Models
Odds Ratio
Polymerase Chain Reaction
Population

Cite this

@article{0f1589d2bcd04b89b3f210e5b8469609,
title = "The contribution of viruses and bacteria to community-acquired pneumonia in vaccinated children: A case - Control study",
abstract = "Introduction: Respiratory pathogens associated with childhood pneumonia are often detected in the upper respiratory tract of healthy children, making their contribution to pneumonia difficult to determine. We aimed to determine the contribution of common pathogens to pneumonia adjusting for rates of asymptomatic detection to inform future diagnosis, treatment and preventive strategies. Methods: A case-control study was conducted among children <18 years in Perth, Western Australia. Cases were children hospitalised with radiologically confirmed pneumonia; controls were healthy children identified from outpatient and local immunisation clinics. Nasopharyngeal swabs were collected and tested for 14 respiratory viruses and 6 bacterial species by Polymerase chain reaction (PCR). For each pathogen, adjusted odds ratio (aOR; 95{\%} CI) was calculated using multivariate logistic regression and population-attributable fraction (95{\%} CI) for pneumonia was estimated. Results: From May 2015 to October 2017, 230 cases and 230 controls were enrolled. At least one respiratory virus was identified in 57{\%} of cases and 29{\%} of controls (aOR: 4.7; 95{\%} CI: 2.8 to 7.8). At least one bacterial species was detected in 72{\%} of cases and 80{\%} of controls (aOR: 0.7; 95{\%} CI: 0.4 to 1.2). Respiratory syncytial virus (RSV) detection was most strongly associated with pneumonia (aOR: 58.4; 95{\%} CI: 15.6 to 217.5). Mycoplasma pneumoniae was the only bacteria associated with pneumonia (aOR: 14.5; 95{\%} CI: 2.2 to 94.8). We estimated that RSV, human metapneumovirus (HMPV), influenza, adenovirus and Mycoplasma pneumoniae were responsible for 20.2{\%} (95{\%} CI: 14.6 to 25.5), 9.8{\%} (5.6{\%} to 13.7{\%}), 6.2{\%} (2.5{\%} to 9.7{\%}), 4{\%} (1.1{\%} to 7.1{\%}) and 7.2{\%} (3.5{\%} to 10.8{\%}) of hospitalisations for childhood pneumonia, respectively. Conclusions: Respiratory viruses, particularly RSV and HMPV, are major contributors to pneumonia in Australian children.",
keywords = "clinical epidemiology, pneumonia, viral infection",
author = "Bhuiyan, {Mejbah Uddin} and Snelling, {Thomas L.} and Rachel West and Jurissa Lang and Tasmina Rahman and Caitlyn Granland and {De Gier}, Camilla and Borland, {Meredith L.} and Thornton, {Ruth B.} and Kirkham, {Lea Ann S.} and Chisha Sikazwe and Martin, {Andrew C.} and Richmond, {Peter C.} and Smith, {David W.} and Adam Jaffe and Blyth, {Christopher C.}",
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The contribution of viruses and bacteria to community-acquired pneumonia in vaccinated children : A case - Control study. / Bhuiyan, Mejbah Uddin; Snelling, Thomas L.; West, Rachel; Lang, Jurissa; Rahman, Tasmina; Granland, Caitlyn; De Gier, Camilla; Borland, Meredith L.; Thornton, Ruth B.; Kirkham, Lea Ann S.; Sikazwe, Chisha; Martin, Andrew C.; Richmond, Peter C.; Smith, David W.; Jaffe, Adam; Blyth, Christopher C.

In: Thorax, Vol. 74, No. 3, 03.2019, p. 261-269.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The contribution of viruses and bacteria to community-acquired pneumonia in vaccinated children

T2 - A case - Control study

AU - Bhuiyan, Mejbah Uddin

AU - Snelling, Thomas L.

AU - West, Rachel

AU - Lang, Jurissa

AU - Rahman, Tasmina

AU - Granland, Caitlyn

AU - De Gier, Camilla

AU - Borland, Meredith L.

AU - Thornton, Ruth B.

AU - Kirkham, Lea Ann S.

AU - Sikazwe, Chisha

AU - Martin, Andrew C.

AU - Richmond, Peter C.

AU - Smith, David W.

AU - Jaffe, Adam

AU - Blyth, Christopher C.

PY - 2019/3

Y1 - 2019/3

N2 - Introduction: Respiratory pathogens associated with childhood pneumonia are often detected in the upper respiratory tract of healthy children, making their contribution to pneumonia difficult to determine. We aimed to determine the contribution of common pathogens to pneumonia adjusting for rates of asymptomatic detection to inform future diagnosis, treatment and preventive strategies. Methods: A case-control study was conducted among children <18 years in Perth, Western Australia. Cases were children hospitalised with radiologically confirmed pneumonia; controls were healthy children identified from outpatient and local immunisation clinics. Nasopharyngeal swabs were collected and tested for 14 respiratory viruses and 6 bacterial species by Polymerase chain reaction (PCR). For each pathogen, adjusted odds ratio (aOR; 95% CI) was calculated using multivariate logistic regression and population-attributable fraction (95% CI) for pneumonia was estimated. Results: From May 2015 to October 2017, 230 cases and 230 controls were enrolled. At least one respiratory virus was identified in 57% of cases and 29% of controls (aOR: 4.7; 95% CI: 2.8 to 7.8). At least one bacterial species was detected in 72% of cases and 80% of controls (aOR: 0.7; 95% CI: 0.4 to 1.2). Respiratory syncytial virus (RSV) detection was most strongly associated with pneumonia (aOR: 58.4; 95% CI: 15.6 to 217.5). Mycoplasma pneumoniae was the only bacteria associated with pneumonia (aOR: 14.5; 95% CI: 2.2 to 94.8). We estimated that RSV, human metapneumovirus (HMPV), influenza, adenovirus and Mycoplasma pneumoniae were responsible for 20.2% (95% CI: 14.6 to 25.5), 9.8% (5.6% to 13.7%), 6.2% (2.5% to 9.7%), 4% (1.1% to 7.1%) and 7.2% (3.5% to 10.8%) of hospitalisations for childhood pneumonia, respectively. Conclusions: Respiratory viruses, particularly RSV and HMPV, are major contributors to pneumonia in Australian children.

AB - Introduction: Respiratory pathogens associated with childhood pneumonia are often detected in the upper respiratory tract of healthy children, making their contribution to pneumonia difficult to determine. We aimed to determine the contribution of common pathogens to pneumonia adjusting for rates of asymptomatic detection to inform future diagnosis, treatment and preventive strategies. Methods: A case-control study was conducted among children <18 years in Perth, Western Australia. Cases were children hospitalised with radiologically confirmed pneumonia; controls were healthy children identified from outpatient and local immunisation clinics. Nasopharyngeal swabs were collected and tested for 14 respiratory viruses and 6 bacterial species by Polymerase chain reaction (PCR). For each pathogen, adjusted odds ratio (aOR; 95% CI) was calculated using multivariate logistic regression and population-attributable fraction (95% CI) for pneumonia was estimated. Results: From May 2015 to October 2017, 230 cases and 230 controls were enrolled. At least one respiratory virus was identified in 57% of cases and 29% of controls (aOR: 4.7; 95% CI: 2.8 to 7.8). At least one bacterial species was detected in 72% of cases and 80% of controls (aOR: 0.7; 95% CI: 0.4 to 1.2). Respiratory syncytial virus (RSV) detection was most strongly associated with pneumonia (aOR: 58.4; 95% CI: 15.6 to 217.5). Mycoplasma pneumoniae was the only bacteria associated with pneumonia (aOR: 14.5; 95% CI: 2.2 to 94.8). We estimated that RSV, human metapneumovirus (HMPV), influenza, adenovirus and Mycoplasma pneumoniae were responsible for 20.2% (95% CI: 14.6 to 25.5), 9.8% (5.6% to 13.7%), 6.2% (2.5% to 9.7%), 4% (1.1% to 7.1%) and 7.2% (3.5% to 10.8%) of hospitalisations for childhood pneumonia, respectively. Conclusions: Respiratory viruses, particularly RSV and HMPV, are major contributors to pneumonia in Australian children.

KW - clinical epidemiology

KW - pneumonia

KW - viral infection

UR - http://www.scopus.com/inward/record.url?scp=85055199796&partnerID=8YFLogxK

U2 - 10.1136/thoraxjnl-2018-212096

DO - 10.1136/thoraxjnl-2018-212096

M3 - Article

VL - 74

SP - 261

EP - 269

JO - Thorax

JF - Thorax

SN - 0040-6376

IS - 3

ER -