From the Influenza Program, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya.
Centers for Disease Control and Prevention (CDC), Infectious Diseases Pathology Branch, Atlanta, Georgia.
Pediatr Infect Dis J. 2021 Aug 1;40(8):715-722. doi: 10.1097/INF.0000000000003159.
In resource-limited settings, acute respiratory infections continue to be the leading cause of death in young children. We conducted postmortem investigations in children <5 years hospitalized with a clinical diagnosis of respiratory disease at Kenya's largest referral hospital.
We collected respiratory and other tissues postmortem to examine pathologic processes using histology, molecular and immunohistochemistry assays. Nasopharyngeal, trachea, bronchi and lung specimens were tested using 21-target respiratory pathogen real-time reverse transcription polymerase chain reaction assays deployed on Taqman Array Cards. Expert panels reviewed all findings to determine causes of death and associated pathogens.
From 2014 to 2015, we investigated 64 pediatric deaths (median age 7 months). Pneumonia was determined as cause of death in 70% (42/52) of cases where death was associated with an infectious disease process. The main etiologies of pneumonia deaths were respiratory syncytial virus (RSV) (n = 7, 19%), Pneumocystis jirovecii (n = 7, 19%), influenza A (n = 5, 14%) and Streptococcus pneumoniae (n = 5, 14%)-10% of cases had multi-pathogen involvement. Among the other 10 deaths associated with a nonpneumonia infectious process, 4 did not have an etiology assigned, the others were associated with miliary tuberculosis (2), cerebral thrombosis due to HIV (1), Enterobacteriaceae (1), rotavirus (1), and 1 case of respiratory infection with severe hypokalemia associated with RSV.
In spite of well-established vaccination programs in Kenya, some deaths were still vaccine preventable. Accelerated development of RSV monoclonal antibodies and vaccines, introduction of seasonal influenza vaccination, and maintenance or improved uptake of existing vaccines can contribute to further reductions in childhood mortality.
在资源有限的环境下，急性呼吸道感染仍然是导致 5 岁以下儿童死亡的主要原因。我们对肯尼亚最大的转诊医院住院的临床诊断为呼吸道疾病的 5 岁以下儿童进行了尸检调查。
我们收集了呼吸道和其他组织的样本，通过组织病理学、分子和免疫组织化学检测来检查病理过程。使用 Taqman Array 卡上的 21 目标呼吸道病原体实时逆转录聚合酶链反应检测试剂盒对鼻咽、气管、支气管和肺标本进行了检测。专家小组审查了所有的发现，以确定死亡原因和相关病原体。
2014 年至 2015 年，我们调查了 64 名儿科死亡病例（中位年龄 7 个月）。在与传染病过程相关的死亡病例中，70%（42/52）的病例被确定为肺炎是死亡原因。肺炎死亡的主要病因是呼吸道合胞病毒（RSV）（n = 7，19%）、卡氏肺孢子虫（n = 7，19%）、甲型流感（n = 5，14%）和肺炎链球菌（n = 5，14%）-10%的病例存在多病原体感染。在与非肺炎感染过程相关的其他 10 例死亡中，有 4 例没有确定病因，其余与粟粒性肺结核（2 例）、艾滋病毒引起的脑血栓（1 例）、肠杆菌科（1 例）、轮状病毒（1 例）和 1 例与 RSV 相关的严重低钾血症的呼吸道感染有关。
尽管肯尼亚有成熟的疫苗接种计划，但仍有一些死亡是可以通过疫苗预防的。加速 RSV 单克隆抗体和疫苗的开发，引入季节性流感疫苗接种，并维持或提高现有疫苗的接种率，有助于进一步降低儿童死亡率。
