Epidemiology and Etiology of Hospitalized Pneumonia in Children

儿童住院肺炎的流行病学和病因学

• 批准号: 7773889
• 负责人: Krow Ampofo
• 金额: $ 86.43万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7773889
• 关键词: Epidemiology; Etiology; Hospitalized; Pneumonia; Children

DESCRIPTION (provided by applicant): Pneumonia in children is a major cause of morbidity and mortality worldwide and the leading cause of death in children younger than 5 years of age worldwide. Among children in the United States, pneumonia and influenza are the eighth leading causes of death. Although the burden of pneumonia in children is well appreciated, recent data on the incidence and etiology of pneumonia in children are few. Moreover, the epidemiology of childhood pneumonia is changing due to the impact of Haemophilus influenzae type b (Hib) vaccine and pneumococcal conjugate vaccine, and the emergence of non-vaccine serotypes of Streptococcus pneumioniae and highly virulent clones of methcillin resistant Staphylococcus aureus (MRSA). Several respiratory viruses have been recognized in recent years, and there is increased recognition of the impact of influenza in causing primary pneumonia as well as life-threatening secondary infections. Determining the true etiology of pneumonia has been difficult. The primary reasons for this are: 1) the large number of bacterial and viral agents that may cause pneumonia; 2) the frequency of viral and bacterial co- infections; 3) the limited availability of deep respiratory specimens from children; 4) the limitations of current laboratory technology; and 5) antibiotic therapy initiated before microbiological evaluation. These limitations result in empirical clinical management of children with pneumonia. The optimum management of pediatric pneumonia is dependent on understanding the epidemiology of the pathogens that cause pneumonia by age and geographic region. The University of Utah, in collaboration with the Associated and Regional University Pathologists Laboratories and Research Enterprise, as well as Idaho Technology, Inc., is uniquely suited to address this problem. We have been performing population-based studies of respiratory infections in Salt Lake County, a region with one of the highest birth rates in the US, have outstanding information technology resources, and have extensive experience with standard and novel molecular diagnostic tests. The Specific Aims of this proposal are: Specific Aim 1: Identify all children (1 week to 18 years of age) residing in Salt Lake County hospitalized for clinically diagnosed and radiologically-confirmed, community-acquired pneumonia. Enroll all children meeting a strict case definition (estimated number > 500/year) into a prospective clinical study to determine the incidence, etiology and outcomes of pneumonia among hospitalized children, using state of the art diagnostic methods. Specific Aim 2: Determine the incidence, etiology and outcomes of pediatric influenza-associated pneumonia in Salt Lake County, including primary viral pneumonia, viral and bacterial co-infection, and post-influenza bacterial pneumonia. Specific Aim 3: Document the etiology of pediatric pneumonia due to established and emerging pathogens using molecular analysis and a novel diagnostic platform. a. Improve the ability to identify the etiology of presumed bacterial infection using molecular analysis of pleural fluid and blood. b. Expand the range of pathogens evaluated as potential causes of hospitalized pediatric pneumonia to include emerging viruses such as non-SARS coronaviruses, parainfluenza virus 4 (PIV 4) human metapneumovirus, rhinoviruses, and bocavirus. The successful achievement of these Specific Aims will allow us to determine the incidence and etiology of pediatric hospitalized pneumonia and to further understand the complications associated with influenza. PUBLIC HEALTH RELEVANCE: Our study, Epidemiology and Etiology of Hospitalized Pneumonia in Children, supports and addresses the National Center for Immunization and Respiratory Diseases (NCIRD) of CDC objectives of "Healthy People 2010" to prevent disease, disability, and death from infectious diseases, including vaccine-preventable diseases to protect Americans from infectious diseases. It will lead to improved understanding of the spectrum of viruses and bacteria responsible for pneumonia will aid in appropriate choices of antimicrobial therapy. Understanding the frequency and etiology of bacterial infections following influenza will aid in pandemic planning. The data obtained from the proposed studies will be vital for evidence-based management of pneumonia in children.

描述(申请人提供)：儿童肺炎是全球发病率和死亡率的主要原因，也是全球5岁以下儿童死亡的主要原因。在美国儿童中，肺炎和流感是第八大死因。尽管儿童肺炎的负担得到了很好的认识，但最近关于儿童肺炎发病率和病原学的数据很少。此外，由于b型流感嗜血杆菌(Hib)疫苗和肺炎球菌结合疫苗的影响，以及非疫苗血清型肺炎链球菌和高毒力耐甲氧西林金黄色葡萄球菌(MRSA)克隆的出现，儿童肺炎的流行病学正在发生变化。近年来发现了几种呼吸道病毒，人们越来越多地认识到流感在导致初级肺炎和危及生命的继发性感染方面的影响。确定肺炎的真正病因一直很困难。造成这种情况的主要原因是：1)可能导致肺炎的大量细菌和病毒制剂；2)病毒和细菌混合感染的频率；3)儿童深部呼吸道样本的可获得性有限；4)目前实验室技术的局限性；以及5)在微生物评估之前开始的抗生素治疗。这些局限性导致了对肺炎儿童的经验性临床治疗。儿童肺炎的最佳管理取决于按年龄和地理区域了解引起肺炎的病原体的流行病学。 犹他大学与联合和地区大学病理学家实验室和研究企业以及爱达荷州技术公司合作，是唯一适合解决这一问题的机构。我们一直在盐湖县进行以人群为基础的呼吸道感染研究，盐湖县是美国出生率最高的地区之一，拥有出色的信息技术资源，并在标准和新型分子诊断测试方面拥有丰富的经验。这项提案的具体目标是：具体目标1：查明所有居住在盐湖县的儿童(1周至18岁)因临床诊断和放射学确诊的社区获得性肺炎而住院。将所有符合严格病例定义(估计人数为500人/年)的儿童纳入一项前瞻性临床研究，以使用最先进的诊断方法确定住院儿童肺炎的发病率、病因和结果。具体目标2：确定盐湖县儿童流感相关肺炎的发病率、病原学和转归，包括原发性病毒性肺炎、病毒和细菌混合感染以及流感后细菌性肺炎。具体目标3：利用分子分析和一个新的诊断平台，记录由已建立的和新出现的病原体引起的儿童肺炎的病原学。A.通过胸液和血液的分子分析，提高识别假定细菌感染的病原学的能力。B.扩大被评估为儿童住院肺炎潜在原因的病原体范围，包括新出现的病毒，如非SARS冠状病毒、副流感病毒4(PIV 4)、人类偏肺病毒、鼻病毒和博卡病毒。这些具体目标的成功实现将使我们能够确定儿科住院肺炎的发病率和病因，并进一步了解与流感相关的并发症。 公共卫生相关性：我们的研究--儿童肺炎住院流行病学和病原学--支持和支持疾控中心国家免疫和呼吸系统疾病中心(NCIRD)“2010年健康人”的目标，以预防传染病(包括疫苗可预防的疾病)导致的疾病、残疾和死亡，以保护美国人免受传染病的侵袭。这将有助于更好地了解导致肺炎的病毒和细菌的谱，将有助于适当选择抗菌治疗。了解流感后细菌感染的频率和病原学将有助于制定大流行规划。从拟议的研究中获得的数据将对儿童肺炎的循证管理至关重要。