Pneumonia Careseeking in Asia

Pneumonia-Careseeking-in-Asia-webinar

Pneumonia Careseeking in Asia Webinar Event

 

November 12, 2019 10:00 AM EDT (US); 15:00 GMT

 

Speakers

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What is pneumococcal pneumonia? Can pneumococcal conjugate vaccines help answer the question?

Lobar pneumonia

Above photo provided by Professor Ron Dagan

 

What is pneumococcal pneumonia? Can pneumococcal conjugate vaccines help answer the question? By Ron Dagan

 

It is well accepted that acute lower respiratory tract infection (LRI) is the leading cause of death in children in developing countries, and the most common cause of hospital visits in young children in the developed world. However, no appropriate clinical definition exists as to what is pneumonia and how to distinguish it from other LRIs. Without such “gold standard” we were unable to predict the potential impact of pneumococcal conjugate vaccines (PCVs) before their implementation.

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JANUARY 2020 PIN Newsletter

SIIL

Above photo obtained from PATH/Satvir Malhotra. A worker at Serum Institute of India inspects vaccine vials at the company’s vaccine manufacturing division where PNEUMOSIL® and other conjugate vaccines are made.

 

A Comment from the Coordinator

 

Happy new year from the Pneumonia Innovations Network (PIN)! Some exciting news to greet the new year. After over a decade of development and research, Serum Institute of India’s PNEUMOSIL®, a new and highly anticipated 10-valent pneumococcal conjugate vaccine has received World Health Organization pre-qualification with a target price of US$2 per dose.

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Global Forum on Childhood Pneumonia 29-31 January 2020

Every Breath Counts https://stoppneumonia.org/latest/global-forum/

The Global Forum on Childhood Pneumonia is a major opportunity to ensure that pneumonia is at the forefront of national and global health agendas; galvanise national action, and mobilise the donor community to increase awareness of the scale of the pneumonia challenge.

 

ISGlobal, Save the Children, UNICEF, Every Breath Counts, Bill & Melinda Gates Foundation, ”la Caixa” Foundation, USAID, Unitaid and Gavi have joined forces to address one of the greatest and gravest health challenges facing children around the world.

 

As the world’s first conference on childhood pneumonia – taking place on 29-31 January 2020 at CosmoCaixa in Barcelona, Spain – the Global Forum sets out to agree practical pathways that governments and their partners can take to meet the Sustainable Development Goal on child survival and the Global Action Plan for Pneumonia and Diarrhea (GAPPD) target of three child pneumonia deaths per 1,000 live births.

 

This is not a forum for reflection, but a call to action to deliver concrete measures with the potential to save hundreds of thousands of children’s lives.

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Risk factors associated with Streptococcus pneumonia carriage in children under five years old with acute respiratory infection in Niger

 By Dano, Ibrahim Dan et al

 

The Pan African Medical Journal , July 19, 2019

 

A questionnaire was addressed to parents for the collection of sociodemographic and medical information. Nasopharyngeal swabbing was processed using a molecular method. We used logistic regression models to examine independent associations between pneumococcal carriage and potential risk factors. All associations with a p-value of < 0.25 in the bivariate regression analyses were subsequently entered in the multivariate regression model.

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Invasive Pneumococcal and Meningococcal Disease

By Fitzgerald D, Waterer GW

 

Infectious Disease Clinics of North America, December 2019

 

This review focuses on current knowledge of the epidemiology, prevention, and treatment of invasive pneumococcal (IPD) and meningococcal disease (IMD). IPD decreased significantly with the introduction of effective conjugate vaccines but is on the rise again. Effective antibiotic therapy of IPD includes the combination of a beta-lactam and a macrolide with additional considerations in meningitis. Steroids are mandatory in pneumococcal meningitis but not indicated in pneumococcal pneumonia except in the setting of refractory shock. There is increasing concern about the cardiovascular complications of IPD. IMD continues to be a significant health problem with major concerns about rising antibiotic resistance.

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Antibiotic-Resistant Community-Acquired Bacterial Pneumonia

By Jeffery Ho and Margaret Ip

Infectious Disease Clinics of North America, December, 2019

Antimicrobial resistance is a global concern, and prudent use of antibiotics is essential to preserve the current armamentarium of effective drugs. Acute respiratory tract infection is the most common reason for antibiotic prescription in adults. In particular, community-acquired pneumonia poses a significant health challenge and economic burden globally, especially in the current landscape of a dense and aging population. By updating the knowledge on the common antimicrobial-resistant pathogens in community-acquired respiratory tract infections, their prevalence, and resistance may pave the way to enhancing appropriate antibiotic use in the ambulatory and health care setting.

 

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Quality of care for children with severe disease in the Democratic Republic of the Congo

By Clarke-Deelder E, Shapira G, Samaha H, Fritsche GB, Fink G

BMC Public Health, December 2,  2019

 

Despite the almost universal adoption of Integrated Management of Childhood Illness (IMCI) guidelines for the diagnosis and treatment of sick children under the age of five in low- and middle-income countries, child mortality remains high in many settings. One possible explanation of the continued high mortality burden is lack of compliance with diagnostic and treatment protocols. We test this hypothesis in a sample of children with severe illness in the Democratic Republic of the Congo (DRC).

 

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Challenges in the diagnosis of paediatric pneumonia in intervention field trials: recommendations from a pneumonia field trial working group

By Dina Goodman, Mary E Crocker, Farhan Pervaiz, Eric D McCollum,  Kyle Steenland, Suzanne M Simkovich, et al.

 

The Lancet Respiratory Medicine, December 1, 2019

 

Pneumonia is a leading killer of children younger than 5 years despite high vaccination coverage, improved nutrition, and widespread implementation of the Integrated Management of Childhood Illnesses algorithm. Assessing the effect of interventions on childhood pneumonia is challenging because the choice of case definition and surveillance approach can affect the identification of pneumonia substantially. In anticipation of an intervention trial aimed to reduce childhood pneumonia by lowering household air pollution, we created a working group to provide recommendations regarding study design and implementation. We suggest to, first, select a standard case definition that combines acute (≤14 days) respiratory symptoms and signs and general danger signs with ancillary tests (such as chest imaging and pulse oximetry) to improve pneumonia identification; second, to prioritise active hospital-based pneumonia surveillance over passive case finding or home-based surveillance to reduce the risk of non-differential misclassification of pneumonia and, as a result, a reduced effect size in a randomised trial; and, lastly, to consider longitudinal follow-up of children younger than 1 year, as this age group has the highest incidence of severe pneumonia.

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Assessment and Validation of Syndromic Case Definitions for Respiratory Syncytial Virus Infections in Young Infants A Latent Class Analysis

By Lalani, Karim MD; Yildirim, Inci, Phadke, Varun K. MD; Bednarczyk, Robert A.; Omer, Saad B.

The Pediatric Infectious Disease Journal, December 2019

 

Respiratory syncytial virus (RSV) is a major cause of pediatric morbidity and mortality worldwide. Standardized case definitions that are applicable to variety of populations are critical for robust surveillance systems to guide decision-making regarding RSV control strategies including vaccine evaluation. Limited data exist on performance of RSV syndromic case definitions among young infants or in high-resource settings.

The purpose of this study was to evaluate existing and potential syndromic case definitions for RSV among young infants in an urban, high-income setting using latent class analyses (LCA).

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Comprehensive Detection of Respiratory Bacterial and Viral Pathogens in the Middle Ear Fluid and Nasopharynx of Pediatric Patients With Acute Otitis Media

By Sawada, Shoichi M.,Okutani, Fumino, Kobayashi, Taisuke.

 

The Pediatric Infectious Disease Journal, December 2019

 

Acute otitis media (AOM) is a common ear infection caused by respiratory viruses and bacteria of the nasopharynx. The present study aimed to detect various respiratory viruses and bacteria in middle ear fluid (MEF) and nasopharyngeal aspirates (NPA) using polymerase chain reaction (PCR).

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Increasing Rates of Pediatric Empyema and Disease Severity With Predominance of Serotype 3 S. pneumonia

By Haggie, Stuart, Fitzgerald, Dominic A, Pandit, Chetan, Selvadurai, Hiran, Robinson, Paul, Gunasekera, Hasantha,, Britton, Philip.

The Pediatric Infectious Disease Journal: December 2019.

 A retrospective study between 2011 and 2018 of empyema cases admitted to a large pediatric referral hospital, for management with either pleural drainage and fibrinolytics or surgical intervention.

There were 195 cases in 8 years. Empyema incidence and ICU admission rates significantly increased during the study with a peak incidence of 7.1/1000 medical admissions in 2016 (χ2 for trend of incidence 37.8, P < 0.001 and for ICU admissions 15.3, P < 0.001). S. pneumoniae was the most common pathogen (75/195, 39%) with serotype 3 the most detected (27/75: 27%). S. pyogenes compared with S. pneumoniae had significantly fewer days of fever before admission (3.9 vs. 6.4, mean difference 2.4, 95% CI: 0.84–4.08, P = 0.003) and higher proportion requiring direct ICU admission (6/75; 8% vs. 7/15; 47%, P < 0.001). Compared with S. pneumoniae, cases with no pathogen detected by culture or PCR had fewer days of fever post intervention (4.4 vs. 7.4 days, mean difference 2.7 days, P = 0.002). S. aureus occurred more commonly in infants (10/25; 40% vs. 1/75; 1%, P < 0.001) and children of indigenous background (5/25; 20% vs. 1/75; 1%, P < 0.001) compared with S. pneumoniae.

We report increasing rates of pediatric empyema with higher proportions requiring ICU treatment. The most common pathogens detected were S. pneumoniae, S. aureus and S. pyogenes. Despite high 13-valent pneumococcal conjugate vaccine coverage, serotype 3 was the most common S. pneumoniae serotype identified.

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Potential effect of age of BCG vaccination on global paediatric tuberculosis mortality: a modelling study

By Partho Roy, Johan Vekemans, Andrew Clark, Colin Sanderson, Rebecca C Harris, Richard G White.

 

The Lancet, Global Health, December 1, 2019

 

BCG has been recommended at birth in countries with a high tuberculosis burden for decades, yet delayed vaccination is widespread. To support a WHO guidance review, we estimated the potential global tuberculosis mortality benefit of administering BCG on time and consequences of later administration.

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Chest ultrasound compared to chest X‐ray for pediatric pulmonary tuberculosis

By Heuvelings CC, Bélard S, Andronikou S, Lederman H, Moodley H, Grobusch MP, Zar HJ.

Pediatric Pulmonology, December 2019

 

Chest ultrasound is increasingly used to radiologically diagnose childhood pneumonia, but there are limited data on its use for pulmonary tuberculosis (PTB).

 Children (up to 13 years) with suspected PTB were enrolled. Bedside chest ultrasound findings were compared to CXR. The analysis was stratified by PTB category: confirmed PTB (microbiologically confirmed), unconfirmed PTB (clinical diagnosis with negative microbiological tests), or unlikely PTB (other respiratory diseases with improvement without tuberculosis treatment).

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Place of death, care-seeking and care pathway progression in the final illnesses of children under five years of age in sub-Saharan Africa: a systematic review

By Jessica Price, Joseph Lee, Merlin Willcox, and Anthony Harnden

 

Journal of Global Health, December, 2019

 

Half of all under-5 deaths occur in sub-Saharan Africa. Reducing child mortality requires understanding of the modifiable factors that contribute to death. Social autopsies collect information about place of death, care-seeking and care-provision, but this has not been pooled to learn wider lessons. We therefore undertook a systematic review to collect, evaluate, map, and pool all the available evidence for sub-Saharan Africa.

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Effect of co-trimoxazole prophylaxis on morbidity and mortality of HIV-exposed, HIV-uninfected infants in South Africa: a randomised controlled, non-inferiority trial

By Brodie Daniels, Anna Coutsoudis, Eshia Moodley-Govender, Helen Mulol, Elizabeth Spooner, Photini Kiepiela, et al.

The Lancet Global Health, December, 2019

WHO guidelines recommend co-trimoxazole prophylaxis for HIV-exposed, HIV-uninfected infants. These guidelines date back to an era in which HIV testing of infants was impossible and mothers had poor access to antiretroviral treatment. To determine whether this guideline requires revision in the current era of effective prevention of mother-to-child transmission and early infant diagnosis programmes, we aimed to investigate whether receiving no co-trimoxazole prophylaxis is inferior to receiving co-trimoxazole prophylaxis in the resulting incidence of grade 3 or 4 common childhood illnesses or mortality in breastfed HIV-exposed, HIV-uninfected infants.

We screened 1570 mother–child pairs for study enrolment, from whom (78%) eligible infants were enrolled into the study between Oct 16, 2013, and May 23, 2018. Of the infants enrolled, 611 (50%) were randomly assigned to the co-trimoxazole group and 609 (50%) were randomly assigned to the no co-trimoxazole group. One (<1%) infant in the no co-trimoxazole group was excluded from the analysis of the final outcomes for having received traditional medicine (which only became apparent after randomisation); therefore, 611 (50%) infants in the co-trimoxazole group and 608 (50%) infants in the no co-trimoxazole group were included in the final intention-to-treat analysis. 136 (22%) infants in the co-trimoxazole group and 139 (23%) infants in the no co-trimoxazole group did not complete the 12-month study visit, predominantly because of loss to follow-up (93 [15%] infants in the co-trimoxazole group; 90 [15%] infants in the no co-trimoxazole group). The cumulative probability of the composite primary outcome was 0·114 (95% CI 0·076 to 0·147; 49 events) in the co-trimoxazole group versus 0·0795 (0·044 to 0·115; 39 events) in the no co-trimoxazole group. The risk difference (no co-trimoxazole group minus co-trimoxazole group) was −0·0319 (–0·075 to 0·011), meaning that the risk was around 3 percentage points lower in the no co-trimoxazole group on the additive scale.

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Safety and Efficacy of C-reactive Protein–guided Antibiotic Use to Treat Acute Respiratory Infections in Tanzanian Children: A Planned Subgroup Analysis of a Randomized Controlled Noninferiority Trial Evaluating a Novel Electronic Clinical Decision Algorithm (ePOCT)

By Kristina Keitel, Josephine Samaka, John Masimba, Hosiana Temba, Zamzam Said, Frank Kagoro, Tarsis Mlaganile, Willy Sangu, Blaise Genton, Valerie D’Acremont

Clinical Infectious Diseases, December 2019

This was a randomized (1:1) controlled noninferiority trial in 9 primary care centers in Tanzania (substudy of the ePOCT trial evaluating a novel electronic decision algorithm). Children aged 2–59 months with fever and cough and without life-threatening conditions received an antibiotic based on a CRP-informed strategy (combination of CRP ≥80 mg/L plus age/temperature-corrected tachypnea and/or chest indrawing) or current World Health Organization standard (respiratory rate ≥50 breaths/minute). The primary outcome was clinical failure by day (D) 7; the secondary outcomes were antibiotic prescription at D0, secondary hospitalization, or death by D30.

A total of 1726 children were included (intervention: 868, control: 858; 0.7% lost to follow-up). The proportion of clinical failure by D7 was 2.9% (25/865) in the intervention arm vs 4.8% (41/854) in the control arm (risk difference, –1.9% [95% confidence interval {CI}, –3.7% to –.1%]; risk ratio [RR], 0.60 [95% CI, .37–.98]). Twenty of 865 (2.3%) children in the intervention arm vs 345 of 854 (40.4%) in the control arm received antibiotics at D0 (RR, 0.06 [95% CI, .04–.09]). There were fewer secondary hospitalizations and deaths in the CRP arm: 0.5% (4/865) vs 1.5% (13/854) (RR, 0.30 [95% CI, .10–.93])..

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A New Way of Managing Pediatric Pneumonia

By McIntosh K

Clinical Infectious Diseases, December, 2019

 

Acute respiratory infections (ARIs) in infants and children <5 years of age have been a target of the World Health Organization (WHO) since the early 1970s. In 1981, a position paper written by an interested group of experts appeared in the Bulletin of the WHO that summarized the scope of the problem and outlined possible approaches to management [1]. By that time, the WHO oral rehydration therapy (ORT) program had already been launched (1980), and childhood mortality from diarrhea was falling dramatically. 

 

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Rapid detection of respiratory organisms with FilmArray respiratory panel and its impact on clinical decisions in Shanghai, China, 2016‐2018

By Yiyi Qian, Jingwen Ai, Jing Wu, Shenglei Yu, Peng Cui, Yan Gao, Jialin Jin, Xinhua Weng, Wenhong Zhang

Influenza and Other Respiratory Viruses., December 1,  2019

In this study, we evaluated the diagnostic potential and clinical impact of an automated multiplex PCR platform (the FilmArray Respiratory Panel; FA-RP), specially designed for pathogen detection in respiratory tract infections in adults with unexplained pneumonia (UP).

Between October 2016 and March 2018, the positive rate obtained using FA-RP for UP was 76.8%. The primary pathogens in adults with UP were Influenza A/B (47.3%, 53/112). Compared with the patients before FA-RP was available, patients who underwent FA-RP testing had higher rates of antiviral drug use and antibiotic de-escalation during clinical treatment. FA-RP significantly decreased the total DDDs of antibiotic or antifungal drugs DDDs by 7 days after admission (10.6 ± 2.5 vs 14.1 ± 8.8, P < .01).

The FA-RP is a rapid and sensitive nucleic acid amplification test method for UP diagnosis in adults. The application of FA-RP may lead to a more accurately targeted antimicrobial treatment and reduced use of antibiotic/antifungal drugs.

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Prevalence and clinical impact of VIral Respiratory tract infections in patients hospitalized for Community-Acquired Pneumonia: the VIRCAP study

By Tatarelli P, Magnasco L, Borghesi ML, Russo C, Marra A, Mirabella M, Sarteschi G, Ungaro R, Arcuri C, Murialdo G, Viscoli C, Del Bono V, Nicolini LA

Internal and Emergency Medicine, November 30,  2019

Prevalence and clinical impact of viral respiratory tract infections (VRTIs) on community-acquired pneumonia (CAP) has not been well defined so far. The aims of this study were to investigate the prevalence and the clinical impact of VRTIs in patients with CAP. Prospective study involving adult patients consecutively admitted at medical wards for CAP and tested for VRTIs by real-time PCR on pharyngeal swab. Patients' features were evaluated with regard to the presence of VRTI and aetiology of CAP. Clinical failure was a composite endpoint defined by worsening of signs and symptoms requiring escalation of antibiotic treatment or ICU admission or death within 30 days. 91 patients were enrolled, mean age 65.7 ± 10.6 years, 50.5% female. 62 patients (68.2%) had no viral co-infection while in 29 patients (31.8%) a VRTI was detected; influenza virus was the most frequently identified (41.9%). The two groups were similar in terms of baseline features. In presence of a VRTI, pneumonia severity index (PSI) was more frequently higher than 91 and patients had received less frequently pre-admission antibiotic therapy (adjusted OR 2.689, 95% CI 1.017-7.111, p = 0.046; adjusted OR 0.143, 95% CI 0.030-0.670, p = 0.014). Clinical failure and antibiotic therapy duration were similar with regards to the presence of VRTI and the aetiology of CAP. VRTIs can be detected in almost a third of adults with CAP; influenza virus is the most relevant one. VRTI was associated with higher PSI at admission, but it does not affect patients' outcome.

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