Influenza is a Major Contributor to Childhood Pneumonia in a Tropical Developing Country
Influenza is a Major Contributor to Childhood Pneumonia in a Tropical Developing Country
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DOI：
10.1097/inf.0b013e3181bc23fd
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发表时间：
2010-03-01
影响因子：
3.6
通讯作者：
Luby, Stephen
中科院分区：
文献类型：
--
作者：
Brooks, W. Abdullah;Goswami, Doli;Luby, Stephen
背景：肺炎是全球儿童死亡的主要原因。流感在热带发展中国家儿童肺炎中的作用知之甚少。我们对低收入城市学龄前儿童进行了基于人群的监测，以确定其在儿童肺炎中的作用。方法：对达卡贫困城市地区随机选择的家庭进行纵向前瞻性主动监测。从1/5的儿童中收集鼻咽冲洗液进行流感病毒培养分离。收集临床表现和整个病程的临床数据。结果：从2004年4月1日至2007年12月31日，12，062名儿童因符合条件的发热和呼吸道疾病就诊，从2370次鼻咽冲洗中获得321株流感分离株（13.5%），代表16，043个观察儿童年（调整的流感发病率为102次/1000儿童年）。在此期间有8198例肺炎发作（肺炎发病率为511例/1000儿童年）。90名流感阳性儿童（28%）在患病期间发生肺炎。在流感病毒培养阳性的儿童中，患有肺炎的儿童比没有肺炎的儿童年龄小（23.4个月比29.7个月，ANOVA：P < 0.001）。肺炎与甲型流感（H3 N2）的相关性通常高于甲型流感（H1 N1）或B型流感（年龄调整的相对比值（RO）分别为2.98，[95% CI：1.56，5.71]和2.75，[95% CI：1.52，4.98]）。流感与10%的儿童pneumonia.Conclusions：流感是一个主要的贡献者，儿童肺炎都通过高流感感染发病率和高肺炎患病率感染的儿童。在肺炎流行高发的热带地区，它对幼儿肺炎的作用似乎被低估了。预防儿童肺炎的流感疫苗试验是必要的。
Background: Pneumonia is the leading cause of child mortality worldwide. The role of influenza in childhood pneumonia in tropical developing countries is poorly understood. We undertook population-based surveillance among low-income urban preschool children to determine its role in childhood pneumonia.Methods: Longitudinal prospective active surveillance was conducted among randomly selected households in a poor urban area of Dhaka. Nasopharyngeal washes were collected from 1 in 5 children for influenza culture isolation. Clinical data were collected at clinical presentation and through the illness course.Results: From April 1, 2004 through December 31, 2007, 12,062 children presented in clinic with eligible febrile and respiratory illnesses, from whom 321 influenza isolates were obtained from 2370 nasopharyngeal washes (13.5%), representing 16,043 child-years of observation (adjusted influenza incidence 102 episodes/1000 child-years). There were 8198 pneumonia episodes during the period (pneumonia incidence 511 episodes/1000 child-years). Ninety influenza-positive children (28%) developed pneumonia during their illness. Among influenza culture-positive children, those with pneumonia were younger than those without (23.4 vs. 29.7 months, ANOVA: P < 0.001). Pneumonia was more commonly associated with Influenza A (H3N2) than either A (H1N1) or B infections (age-adjusted relative odds (RO) 2.98, [95% CI: 1.56, 5.71] and 2.75, [95% CI: 1.52, 4.98], respectively). Influenza was associated with 10% all childhood pneumonia.Conclusions: Influenza is a major contributor to childhood pneumonia both through high influenza infection incidence and high pneumonia prevalence among infected children. Its contribution to early childhood pneumonia appears under-appreciated in high pneumonia-endemic tropical settings. Influenza vaccine trials against childhood pneumonia are warranted.