肯尼亚婴幼儿严重肺炎的病毒病因。
Viral etiology of severe pneumonia among Kenyan infants and children.
机构信息
Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.
出版信息
JAMA. 2010 May 26;303(20):2051-7. doi: 10.1001/jama.2010.675.
CONTEXT
Pneumonia is the leading cause of childhood death in sub-Saharan Africa. Comparative estimates of the contribution of causative pathogens to the burden of disease are essential for targeted vaccine development.
OBJECTIVE
To determine the viral etiology of severe pneumonia among infants and children at a rural Kenyan hospital using comprehensive and sensitive molecular diagnostic techniques.
DESIGN, SETTING, AND PARTICIPANTS: Prospective observational and case-control study during 2007 in a rural Kenyan district hospital. Participants were children aged 1 day to 12 years, residing in a systematically enumerated catchment area, and who either were admitted to Kilifi District Hospital meeting World Health Organization clinical criteria for severe pneumonia or very severe pneumonia; (2) presented with mild upper respiratory tract infection but were not admitted; or (3) were well infants and children attending for immunization.
MAIN OUTCOME MEASURES
The presence of respiratory viruses and the odds ratio for admission with severe disease.
RESULTS
Of 922 eligible admitted patients, 759 were sampled (82% [median age, 9 months]). One or more respiratory viruses were detected in 425 of the 759 sampled (56% [95% confidence interval {CI}, 52%-60%]). Respiratory syncytial virus (RSV) was detected in 260 participants (34% [95% CI, 31%-38%]) and other respiratory viruses were detected in 219 participants (29%; 95% CI, 26%-32%), the most common being Human coronavirus 229E (n = 51 [6.7%]), influenza type A (n = 44 [5.8%]), Parainfluenza type 3 (n = 29 [3.8%]), Human adenovirus (n = 29 [3.8%]), and Human metapneumovirus (n = 23 [3.0%]). Compared with well control participants, detection of RSV was associated with severe disease (5% [corrected] in control participants; adjusted odds ratio, 6.11 [95% CI, 1.65-22.6]) while collectively, other respiratory viruses were not associated with severe disease (23% in control participants; adjusted odds ratio, 1.27 [95% CI, 0.64-2.52]).
CONCLUSION
In a sample of Kenyan infants and children admitted with severe pneumonia to a rural hospital, RSV was the predominant viral pathogen.
背景
肺炎是撒哈拉以南非洲儿童死亡的主要原因。比较病原体对疾病负担的贡献的估计对于有针对性的疫苗开发至关重要。
目的
使用综合和敏感的分子诊断技术，确定肯尼亚农村一家医院中婴儿和儿童严重肺炎的病毒病因。
设计、地点和参与者：2007 年在肯尼亚农村地区医院进行的前瞻性观察性和病例对照研究。参与者为 1 天至 12 岁的儿童，居住在系统地枚举的集水区中，且符合世界卫生组织严重肺炎或极严重肺炎临床标准而入住基利菲区医院的患者；（2）表现为轻度上呼吸道感染但未住院的患者；或（3）是接受免疫接种的健康婴儿和儿童。
主要结局指标
呼吸道病毒的存在以及因严重疾病入院的优势比。
结果
在 922 名符合条件的入院患者中，有 759 名接受了采样（82%[中位数年龄，9 个月]）。759 名采样患者中有 425 名（56%[95%置信区间{CI}，52%-60%]）检测到一种或多种呼吸道病毒。260 名参与者（34%[95% CI，31%-38%]）检测到呼吸道合胞病毒（RSV），219 名参与者（29%；95%CI，26%-32%）检测到其他呼吸道病毒，最常见的是人类冠状病毒 229E（n=51[6.7%]）、甲型流感病毒（n=44[5.8%]）、副流感病毒 3 型（n=29[3.8%]）、人类腺病毒（n=29[3.8%]）和人类偏肺病毒（n=23[3.0%]）。与健康对照参与者相比，检测到 RSV 与严重疾病相关（对照组中为 5%[校正]；调整后的优势比，6.11[95%CI，1.65-22.6]），而其他呼吸道病毒则与严重疾病无关（对照组中为 23%；调整后的优势比，1.27[95%CI，0.64-2.52]）。
结论
在肯尼亚农村一家医院因严重肺炎入院的儿童样本中，RSV 是主要的病毒病原体。
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