Open AccessNasopharyngeal Pneumococcal Colonization Density Is Associated With Severe Pneumonia in Young Children in the Lao People’s Democratic Republic
Author(s) -
O J J Carr,
Keoudomphone Vilivong,
L Bounvilay,
Eileen M. Dunne,
Jana Lai,
Jocelyn Chan,
Malisa Vongsakid,
Anisone Chanthongthip,
C Siladeth,
Belinda D. Ortika,
Cattram Nguyen,
Mayfong Mayxay,
Paul N. Newton,
Kim Mulholland,
Lien Anh Ha,
Audrey DubotPérès,
Catherine Satzke,
David A. B. Dance,
Fiona M. Russell
Publication year - 2021
Publication title -
the journal of infectious diseases (online. university of chicago press)/the journal of infectious diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.69
H-Index - 252
eISSN - 1537-6613
pISSN - 0022-1899
DOI - 10.1093/infdis/jiab239
Subject(s) - medicine , pneumonia , pneumococcal conjugate vaccine , streptococcus pneumoniae , pneumococcal pneumonia , odds ratio , carriage , confidence interval , pneumococcal infections , pediatrics , immunology , antibiotics , microbiology and biotechnology , biology , pathology
Background No studies have explored the association between pneumococcal nasopharyngeal density and severe pneumonia using the World Health Organization (WHO) 2013 definition. In Lao People’s Democratic Republic (Lao PDR), we determine the association between nasopharyngeal pneumococcal density and severe pneumonia in children. Methods A prospective observational study was undertaken at Mahosot Hospital, Vientiane, from 2014 to mid-2018. Children <5 years admitted with acute respiratory infections (ARIs) were included. Clinical and demographic data were collected alongside nasopharyngeal swabs for pneumococcal quantification by lytA real-time quantitative polymerase chain reaction. Severe pneumonia was defined using the 2013 WHO definition. For pneumococcal carriers, a logistic regression model examined the association between pneumococcal density and severe pneumonia, after adjusting for potential confounders including demographic and household factors, 13-valent pneumococcal conjugate vaccine status, respiratory syncytial virus co-detection, and preadmission antibiotics. Results Of 1268 participants with ARI, 32.3% (n = 410) had severe pneumonia and 36.9% (n = 468) had pneumococcal carriage. For pneumococcal carriers, pneumococcal density was positively associated with severe pneumonia (adjusted odds ratio, 1.4 [95% confidence interval, 1.1–1.8]; P = .020). Conclusions Among children with ARIs and pneumococcal carriage, pneumococcal carriage density was positively associated with severe pneumonia in Lao PDR. Further studies may determine if pneumococcal density is a useful marker for pneumococcal conjugate vaccine impact on childhood pneumonia.