David M le Roux1,2, Mark P Nicol3, Landon Myer4, Aneesa Vanker1, Jacob A M Stadler1,4, Eckart von Delft5, Heather J Zar1. 1. Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. 2. Department of Paediatrics, New Somerset Hospital, Cape Town, South Africa. 3. Division of Medical Microbiology, University of Cape Town and National Health Laboratory Service, Cape Town, South Africa. 4. Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. 5. Department of Paediatrics, Paarl Hospital, Cape Town, South Africa.
Abstract
BACKGROUND: Childhood lower respiratory tract infections (LRTIs) cause substantial morbidity and under-5 child mortality. The epidemiology of LRTI is changing in low- and middle-income countries with expanding access to conjugate vaccines, yet there are few data on the incidence and risk factors for LRTI in these settings. METHODS: A prospective birth cohort enrolled mother-infant pairs in 2 communities near Cape Town, South Africa. Active surveillance for LRTI was performed for the first 2 years of life over 4 respiratory seasons. Comprehensive data collection of risk factors was done through 2 years of life. World Health Organization definitions were used to classify clinical LRTI and chest radiographs. RESULTS: From March 2012 to February 2017, 1143 children were enrolled and followed until 2 years of age. Thirty-two percent of children were exposed to antenatal maternal smoking; 15% were born at low birth weights. Seven hundred ninety-five LRTI events occurred in 429 children by February 2017; incidence of LRTI was 0.51 and 0.25 episodes per child-year in the first and second years of life, respectively. Human immunodeficiency virus (HIV)-exposed, uninfected infants (vs HIV-unexposed infants) were at increased risk of hospitalized LRTI in the first 6 months of life. In regression models, male sex, low birth weight, and maternal smoking were independent risk factors for both ambulatory and hospitalized LRTI; delayed or incomplete vaccination was associated with hospitalized LRTI. CONCLUSIONS: LRTI incidence was high in the first year of life, with substantial morbidity. Strategies to ameliorate harmful exposures are needed to reduce LRTI burden in vulnerable populations.
BACKGROUND: Childhood lower respiratory tract infections (LRTIs) cause substantial morbidity and under-5 child mortality. The epidemiology of LRTI is changing in low- and middle-income countries with expanding access to conjugate vaccines, yet there are few data on the incidence and risk factors for LRTI in these settings. METHODS: A prospective birth cohort enrolled mother-infant pairs in 2 communities near Cape Town, South Africa. Active surveillance for LRTI was performed for the first 2 years of life over 4 respiratory seasons. Comprehensive data collection of risk factors was done through 2 years of life. World Health Organization definitions were used to classify clinical LRTI and chest radiographs. RESULTS: From March 2012 to February 2017, 1143 children were enrolled and followed until 2 years of age. Thirty-two percent of children were exposed to antenatal maternal smoking; 15% were born at low birth weights. Seven hundred ninety-five LRTI events occurred in 429 children by February 2017; incidence of LRTI was 0.51 and 0.25 episodes per child-year in the first and second years of life, respectively. Human immunodeficiency virus (HIV)-exposed, uninfected infants (vs HIV-unexposed infants) were at increased risk of hospitalized LRTI in the first 6 months of life. In regression models, male sex, low birth weight, and maternal smoking were independent risk factors for both ambulatory and hospitalized LRTI; delayed or incomplete vaccination was associated with hospitalized LRTI. CONCLUSIONS: LRTI incidence was high in the first year of life, with substantial morbidity. Strategies to ameliorate harmful exposures are needed to reduce LRTI burden in vulnerable populations.
Authors: Stanzi M le Roux; Elaine J Abrams; Kirsten A Donald; Kirsty Brittain; Tamsin K Phillips; Allison Zerbe; David M le Roux; Max Kroon; Landon Myer Journal: Lancet Child Adolesc Health Date: 2020-01-10
Authors: H J Zar; D P Moore; S Andronikou; A C Argent; T Avenant; C Cohen; R J Green; G Itzikowitz; P Jeena; R Masekela; M P Nicol; A Pillay; G Reubenson; S A Madhi Journal: Afr J Thorac Crit Care Med Date: 2020-10-13
Authors: Suzanne M Simkovich; Lindsay J Underhill; Miles A Kirby; Dina Goodman; Mary E Crocker; Shakir Hossen; John P McCracken; Oscar de León; Lisa M Thompson; Sarada S Garg; Kalpana Balakrishnan; Gurusamy Thangavel; Ghislaine Rosa; Jennifer L Peel; Thomas F Clasen; Eric D McCollum; William Checkley Journal: ERJ Open Res Date: 2020-03-23
Authors: Sharon A McGrath-Morrow; Julie Gorzkowski; Judith A Groner; Ana M Rule; Karen Wilson; Susanne E Tanski; Joseph M Collaco; Jonathan D Klein Journal: Pediatrics Date: 2020-02-11 Impact factor: 9.703
Authors: Diane M Gray; Catherine J Wedderburn; Rae P MacGinty; Lauren McMillan; Carvern Jacobs; Jacob A M Stadler; Graham L Hall; Heather J Zar Journal: AIDS Date: 2020-03-15 Impact factor: 4.632