Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA): an observational cohort study.
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Saha Samir K, Schrag Stephanie J, El Arifeen Shams, Mullany Luke C, Shahidul Islam Mohammad, Shang Nong, Qazi Shamim A, Zaidi Anita K M, Bhutta Zulfiqar A, Bose Anuradha, Panigrahi Pinaki, Soofi Sajid B, Connor Nicholas E, Mitra Dipak K, Isaac Rita, Winchell Jonas M, Arvay Melissa L, Islam Maksuda, Shafiq Yasir, Nisar Imran, Baloch Benazir, Kabir Furqan, Ali Murtaza, Diaz Maureen H, Satpathy Radhanath, Nanda Pritish, Padhi Bijaya K, Parida Sailajanandan, Hotwani Aneeta, Hasanuzzaman M, Ahmed Sheraz, Belal Hossain Mohammad, Ariff Shabina, Ahmed Imran, Ibne Moin Syed Mamun, Mahmud Arif, Waller Jessica L, Rafiqullah Iftekhar, Quaiyum Mohammad A, Begum Nazma, Balaji Veeraraghavan, Halen Jasmin, Nawshad Uddin Ahmed A S M, Weber Martin W, Hamer Davidson H, Hibberd Patricia L, Sadeq-Ur Rahman Qazi, Mogan Venkat Raghava, Hossain Tanvir, McGee Lesley, Anandan Shalini, Liu Anran, Panigrahi Kalpana, Abraham Asha Mary, Baqui Abdullah H
Аннотация
METHODS: From 2011 to 2014, we identified babies through population-based pregnancy surveillance at five sites in Bangladesh, India, and Pakistan. Babies were visited at home by community health workers up to ten times from age 0 to 59 days. Illness meeting the WHO definition of pSBI and randomly selected healthy babies were referred to study physicians. The primary objective was to estimate proportions of specific infectious causes by blood culture and Custom TaqMan Array Cards molecular assay (Thermo Fisher, Bartlesville, OK, USA) of blood and respiratory samples.
FINDINGS: 6022 pSBI episodes were identified among 63 114 babies (95·4 per 1000 livebirths). Causes were attributed in 28% of episodes (16% bacterial and 12% viral). Mean incidence of bacterial infections was 13·2 (95% credible interval [CrI] 11·2-15·6) per 1000 livebirths and of viral infections was 10·1 (9·4-11·6) per 1000 livebirths. The leading pathogen was respiratory syncytial virus (5·4, 95% CrI 4·8-6·3 episodes per 1000 livebirths), followed by Ureaplasma spp (2·4, 1·6-3·2 episodes per 1000 livebirths). Among babies who died, causes were attributed to 46% of pSBI episodes, among which 92% were bacterial. 85 (83%) of 102 blood culture isolates were susceptible to penicillin, ampicillin, gentamicin, or a combination of these drugs.
INTERPRETATION: Non-attribution of a cause in a high proportion of patients suggests that a substantial proportion of pSBI episodes might not have been due to infection. The predominance of bacterial causes among babies who died, however, indicates that appropriate prevention measures and management could substantially affect neonatal mortality. Susceptibility of bacterial isolates to first-line antibiotics emphasises the need for prudent and limited use of newer-generation antibiotics. Furthermore, the predominance of atypical bacteria we found and high incidence of respiratory syncytial virus indicated that changes in management strategies for treatment and prevention are needed. Given the burden of disease, prevention of respiratory syncytial virus would have a notable effect on the overall health system and achievement of Sustainable Development Goal.
FUNDING: Bill & Melinda Gates Foundation.