Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 May 26;303(20):2051-7.
doi: 10.1001/jama.2010.675.

Viral etiology of severe pneumonia among Kenyan infants and children

James A Berkley  1 , Patrick Munywoki, Mwanajuma Ngama, Sidi Kazungu, John Abwao, Anne Bett, Ria Lassauniére, Tina Kresfelder, Patricia A Cane, Marietjie Venter, J Anthony G Scott, D James Nokes
Affiliations

Viral etiology of severe pneumonia among Kenyan infants and children

James A Berkley et al. JAMA. .

Erratum in

  • JAMA. 2010 Jun 23;303(24):2477

Abstract

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow Diagram for Inclusion and Sampling of Infants and Children with ‘Severe’ or ‘Very Severe’ Pneumonia.
Figure 2
Figure 2
Seasonal Pattern of RSV and Other Viruses Detected Among Infants and Children Admitted with ‘Severe’ or ‘Very Severe’ Pneumonia.
See this image and copyright information in PMC

Comment in

References

    1. Cutts FT, Zaman SM, Enwere G, et al. Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial. Lancet. 2005 Mar 26;365(9465):1139–1146. Apr 1. - PubMed
    1. Mulholland K, Hilton S, Adegbola R, et al. Randomised trial of Haemophilus influenzae type-b tetanus protein conjugate vaccine [corrected] for prevention of pneumonia and meningitis in Gambian infants. Lancet. 1997 Apr 26;349(9060):1191–1197. - PubMed
    1. Scott JA, English M. What are the implications for childhood pneumonia of successfully introducing Hib and pneumococcal vaccines in developing countries? PLoS Med. 2008 Apr 22;5(4):e86. - PMC - PubMed
    1. Karron RA, Wright PF, Belshe RB, et al. Identification of a recombinant live attenuated respiratory syncytial virus vaccine candidate that is highly attenuated in infants. J Infect Dis. 2005 Apr 1;191(7):1093–1104. - PubMed
    1. Wright PF, Karron RA, Belshe RB, et al. The absence of enhanced disease with wild type respiratory syncytial virus infection occurring after receipt of live, attenuated, respiratory syncytial virus vaccines. Vaccine. 2007 Oct 16;25(42):7372–7378. - PMC - PubMed

Publication types