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Abstract
BackgroundReducing 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.MethodsSurveillance 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.ResultsSARI 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.ConclusionsInfluenza 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.
Highlights
Reducing acute respiratory infection burden in children in Africa remains a major priority and challenge
The rates for severe acute respiratory illness (SARI) are lower than what we observed in a similar study conducted over the same time interval in a rural, sparsely populated area of Kenya (Lwak) about 250 km away by road, which found that influenza A and respiratory syncytial virus (RSV) were significant contributors to SARI (20)
The case definition we used for SARI is similar to definitions used for severe and very severe pneumonia by WHO and for ALRI, the only difference being that we added a clinical criterion of oxygen saturation
Summary
Reducing acute respiratory infection burden in children in Africa remains a major priority and challenge. Reducing the substantial public health burden of acute respiratory infection in children in Africa remains a major priority and an immense challenge [1,2]. Despite steady advances in characterizing principal etiologies, incidence, and factors contributing to severe respiratory infection [3,4], knowledge gaps persist [5]. Filling these gaps is critical to ensuring that limited available public health resources can be optimally targeted towards feasible, effective interventions. With massive urbanization in Africa and advent of densely populated informal settlements or slums [16], different respiratory pathogen transmission patterns [17], co-morbidities, and access to health care [18,19] must be considered when comparing with sparsely populated rural areas from where most data on pneumonia epidemiology and etiology have been collected
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