From the Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Pediatr Infect Dis J. 2021 Sep 1;40(9S):S91-S100. doi: 10.1097/INF.0000000000002768.
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.
在泰国，肺炎仍然是新生儿期后 5 岁以下儿童死亡的主要原因。利用肺炎病因研究儿童健康（PERCH）研究的数据，我们详细描述了泰国肺炎病例和病因，为该年龄段的当地治疗和预防策略提供信息。
PERCH 是一项多国家病例对照研究，评估了 1-59 个月住院儿童严重和非常严重肺炎的病因。泰国现场于 2012 年 1 月至 2014 年 2 月期间连续招募儿童 24 个月，2 个省的开始日期交错。病例是患有 2013 年前世界卫生组织定义的严重或非常严重肺炎的住院儿童。社区对照随机选自每个省的卫生服务登记册。分析仅限于 HIV 阴性病例和对照。我们计算了病例与对照之间鼻咽/口咽（NP/OP）聚合酶链反应检测到的病原体流行率的调整比值比（OR）和 95%置信区间（CI）。PERCH 综合分析（PIA）使用贝叶斯潜在变量分析估计病原体特异性病因分数和 95%可信区间。
超过 96%的病例（n=223）和对照（n=659）至少检测到 1 种病原体；86%的病例和 88%的对照中检测到多种病原体。在 98 例胸部 X 线阳性（CXR+）病例中，呼吸道合胞病毒（RSV）的 NP/OP 流行率最高（22.9%），与病例状态的相关性最强（OR 20.5；95%CI：10.2，41.3），占总病因分数的 34.6%。结核病（TB）占 CXR+病例病因分数的 10%（95%CrI：1.6-26%）。
泰国 1-59 个月儿童严重和非常严重 CXR+肺炎住院病例中，超过三分之一归因于 RSV。结核病占病例的 10%，支持在高负担地区对因肺炎住院的儿童进行结核病评估。泰国和其他 PERCH 地点的肺炎病因相似表明，基于 PERCH 研究结果的全球控制策略与泰国和类似环境相关。
