Etiology and Clinical Characteristics of Severe Pneumonia Among Young Children in Thailand: Pneumonia Etiology Research for Child Health (PERCH) Case-Control Study Findings, 2012-2013.

Charatdao Bunthi,Somchai Chuananon,Daniel R Feikin,Tussanee Amorninthapichet,David R Murdoch,Wantana Paveenkittiporn,Malinee Chittaganpitch,Pasakorn Akarasewi,Christine Prosperi,Henry C Baggett,Pongpun Sawatwong,Laura L Hammitt,Katherine L O’Brien,Maria Deloria-Knoll,Somsak Thamthitiwat,Melissa M Higdon,Julia Rhodes,Susan A Maloney

doi:10.1097/inf.0000000000002768

Abstract

Pneumonia remains the leading cause of death among children <5 years of age beyond the neonatal period in Thailand. Using data from the Pneumonia Etiology Research for Child Health (PERCH) Study, we provide a detailed description of pneumonia cases and etiology in Thailand to inform local treatment and prevention strategies in this age group. PERCH, a multi-country case-control study, evaluated the etiology of hospitalized cases of severe and very severe pneumonia among children 1-59 months of age. The Thailand site enrolled children for 24 consecutive months during January 2012-February 2014 with staggered start dates in 2 provinces. Cases were children hospitalized with pre-2013 WHO-defined severe or very severe pneumonia. Community controls were randomly selected from health services registries in each province. Analyses were restricted to HIV-negative cases and controls. We calculated adjusted odds ratios (ORs) and 95% CIs comparing organism prevalence detected by nasopharyngeal/oropharyngeal (NP/OP) polymerase chain reaction between cases and controls. The PERCH Integrated Analysis (PIA) used Bayesian latent variable analysis to estimate pathogen-specific etiologic fractions and 95% credible intervals. Over 96% of both cases (n = 223) and controls (n = 659) had at least 1 organism detected; multiple organisms were detected in 86% of cases and 88% of controls. Among 98 chest Radiograph positive (CXR+) cases, respiratory syncytial virus (RSV) had the highest NP/OP prevalence (22.9%) and the strongest association with case status (OR 20.5; 95% CI: 10.2, 41.3) and accounted for 34.6% of the total etiologic fraction. Tuberculosis (TB) accounted for 10% (95% CrI: 1.6-26%) of the etiologic fraction among CXR+ cases. More than one-third of hospitalized cases of severe and very severe CXR+ pneumonia among children 1-59 months of age in Thailand were attributable to RSV. TB accounted for 10% of cases, supporting evaluation for TB among children hospitalized with pneumonia in high-burden settings. Similarities in pneumonia etiology in Thailand and other PERCH sites suggest that global control strategies based on PERCH study findings are relevant to Thailand and similar settings.

Highlights

Pneumonia remains the leading cause of death among children
To estimate pneumonia burden and etiology, the Thailand Ministry of Public Health (MoPH) and United States Centers for Disease Control and Prevention conducted surveillance for acute lower respiratory tract infection (ALRI) among hospitalized cases in 2 provinces in Thailand from 2003 to 2014.7 From this surveillance among childhood ALRI cases, we estimated the prevalence of pathogens such as influenza (8.2%8) and respiratory syncytial virus (RSV) (19.5%9,10)
After screening all children 1–59 months of age presenting at 2 provincial hospitals in Thailand over a 2-year period and enrolling >90% (n = 224) of eligible severe and very severe pneumonia cases, RSV accounted for the greatest fraction of disease followed by TB

Summary

Objectives

We aimed to enroll 38 controls monthly (25 in Nakhon Phanom and 13 in Sa Kaeo) to ensure at least a 1.5:1 control:case ratio based on projected case enrollment

Methods

Results

Discussion

Conclusion