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Respiratory infection
Original article
The contribution of viruses and bacteria to community-acquired pneumonia in vaccinated children: a case–control study
  1. Mejbah Uddin Bhuiyan1,2,
  2. Thomas L Snelling2,3,
  3. Rachel West2,
  4. Jurissa Lang4,
  5. Tasmina Rahman2,5,
  6. Caitlyn Granland2,
  7. Camilla de Gier2,5,
  8. Meredith L Borland1,6,7,
  9. Ruth B Thornton2,5,
  10. Lea-Ann S Kirkham2,5,
  11. Chisha Sikazwe4,5,
  12. Andrew C Martin8,
  13. Peter C Richmond1,2,8,
  14. David W Smith4,5,
  15. Adam Jaffe9,
  16. Christopher C Blyth1,2,3
  1. 1 Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
  2. 2 Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
  3. 3 Department of Infectious Diseases, Perth Children’s Hospital, Perth, Western Australia, Australia
  4. 4 Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
  5. 5 School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
  6. 6 Emergency Department, Perth Children’s Hospital, Perth, Western Australia, Australia
  7. 7 Division of Emergency Medicine, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
  8. 8 Department of General Paediatrics, Perth Children’s Hospital, Perth, Western Australia, Australia
  9. 9 School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Mejbah Uddin Bhuiyan, Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth WA 6009, Australia; mejbah.bhuiyan{at}uwa.edu.au

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.

  • pneumonia
  • viral infection
  • clinical epidemiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/thoraxjnl-2018-212096

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    Footnotes

    • Contributors MUB: Participant enrolment, data collection, specimen collection, data analysis, first draft manuscript and subsequent versions. TLS: Conceive the study, supervise data collection, supervise data analysis, critical review of manuscript. RW: Participant enrolment, data collection, specimen collection, critical review of manuscript. JL: Laboratory testing, critical review of manuscript. TR: Laboratory testing, critical review of manuscript. CG: Laboratory testing, critical review of manuscript. CdG: Laboratory testing, critical review of manuscript. MLB: Conceive the study, support data collection, critical review of manuscript. RBT: Supervise laboratory testing, interpret laboratory finding, critical review of manuscript. L-ASK: Supervise laboratory testing, interpret laboratory finding, critical review of manuscript. CS: Laboratory testing, critical review of manuscript. ACM: Conceive the study, support data collection, critical review of manuscript. PCR: Conceive the study, critical review of manuscript. DWS: Conceive the study, supervise laboratory testing, interpret laboratory finding, critical review of manuscript. AJ: Conceive the study, critical review of manuscript. CCB: Conceive the study, supervise data collection, interpret laboratory analysis, supervise data analysis, critical review of manuscript.

    • Funding Funding for the study has been provided by the Telethon-Perth Children’s Hospital Research Fund, Perth Children’s Hospital Foundation and Telethon Kids Institute. TLS and CCB are supported by NHMRC Career Development Fellowships.

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

    • Patient consent Written informed consent was obtained from parents/legal guardians of all study participants.

    • Ethics approval The protocol was approved by Human Research Ethics Committee of the Princess Margaret Hospital (PMH HREC REF 2014117EP).

    • Provenance and peer review Not commissioned; externally peer reviewed.

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