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. 2019 Mar;74(3):261-269.
doi: 10.1136/thoraxjnl-2018-212096. Epub 2018 Oct 18.

The contribution of viruses and bacteria to community-acquired pneumonia in vaccinated children: a case - control study

Mejbah Uddin Bhuiyan  1   2 , Thomas L Snelling  2   3 , Rachel West  2 , Jurissa Lang  4 , Tasmina Rahman  2   5 , Caitlyn Granland  2 , Camilla de Gier  2   5 , Meredith L Borland  1   6   7 , Ruth B Thornton  2   5 , Lea-Ann S Kirkham  2   5 , Chisha Sikazwe  4   5 , Andrew C Martin  8 , Peter C Richmond  1   2   8 , David W Smith  4   5 , Adam Jaffe  9 , Christopher C Blyth  1   2   3
Affiliations

The contribution of viruses and bacteria to community-acquired pneumonia in vaccinated children: a case - control study

Mejbah Uddin Bhuiyan et al. Thorax. 2019 Mar.

Abstract

Introduction: Respiratory pathogens associated with childhood pneumonia are often detected in the upper respiratory tract of healthy children, making their contribution to pneumonia difficult to determine. We aimed to determine the contribution of common pathogens to pneumonia adjusting for rates of asymptomatic detection to inform future diagnosis, treatment and preventive strategies.

Methods: A case-control study was conducted among children <18 years in Perth, Western Australia. Cases were children hospitalised with radiologically confirmed pneumonia; controls were healthy children identified from outpatient and local immunisation clinics. Nasopharyngeal swabs were collected and tested for 14 respiratory viruses and 6 bacterial species by Polymerase chain reaction (PCR). For each pathogen, adjusted odds ratio (aOR; 95% CI) was calculated using multivariate logistic regression and population-attributable fraction (95% CI) for pneumonia was estimated.

Results: From May 2015 to October 2017, 230 cases and 230 controls were enrolled. At least one respiratory virus was identified in 57% of cases and 29% of controls (aOR: 4.7; 95% CI: 2.8 to 7.8). At least one bacterial species was detected in 72% of cases and 80% of controls (aOR: 0.7; 95% CI: 0.4 to 1.2). Respiratory syncytial virus (RSV) detection was most strongly associated with pneumonia (aOR: 58.4; 95% CI: 15.6 to 217.5). Mycoplasma pneumoniae was the only bacteria associated with pneumonia (aOR: 14.5; 95% CI: 2.2 to 94.8). We estimated that RSV, human metapneumovirus (HMPV), influenza, adenovirus and Mycoplasma pneumoniae were responsible for 20.2% (95% CI: 14.6 to 25.5), 9.8% (5.6% to 13.7%), 6.2% (2.5% to 9.7%), 4% (1.1% to 7.1%) and 7.2% (3.5% to 10.8%) of hospitalisations for childhood pneumonia, respectively.

Conclusions: Respiratory viruses, particularly RSV and HMPV, are major contributors to pneumonia in Australian children.

Keywords: clinical epidemiology; pneumonia; viral infection.

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Conflict of interest statement

Competing interests: PCR receives grants from GlaxoSmithKline, Novavax, Medimmune and Janssen outside the submitted work; L-ASK has a patent WO2005108580A1 licensed to Pfizer.

Figures

Figure 1
Figure 1
Distribution of respiratory pathogens by participant’s age (in months); dot lines refers to age-group breakdown among study participants; for bacteria, such as Haemophilus influenzae (Hi), Streptococcus pneumoniae (Sp), Moraxella catarrhalis (Mc) and Staphylococcus aureus (Sau), only children without prior antibiotic exposure were included and Mycoplasma pneumoniae (Mp) included all children.
Figure 2
Figure 2
Distribution of respiratory viruses in the nasopharynx of children with community-acquired pneumonia (case group), by seasons, Perth, Western Australia, May 2015–October 2017. HMPV, human metapneumovirus; HPIV, human parainfluenza virus; RSV, respiratory syncytial virus.
Figure 3
Figure 3
Distribution of respiratory viruses in the nasopharynx of healthy children (control group), by seasons, Perth, Western Australia, May 2015–October 2017. HMPV, human metapneumovirus; HPIV, human parainfluenza virus; RSV, respiratory syncytial virus.
Figure 4
Figure 4
Distribution of bacteria in the nasopharynx of children with community-acquired pneumonia (case group), by seasons, Perth, Western Australia, May 2015–October 2017.
Figure 5
Figure 5
Distribution of bacteria in the nasopharynx of healthy children (control group), by seasons, Perth, Western Australia, May 2015–October 2017.
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