Childhood Invasive Bacterial Disease in Kathmandu, Nepal, 2005–2013

Michael Carter, Meeru Gurung, Bhishma Pokhrel, Sanjeev M Bijukchhe, Bijay Khadka, Anju Maharjan, Suraj Bhattarai, Swosti Shrestha, Bibek Khadka, Animesh Khulal, Sunaina Gurung, Bijaya Dhital, Krishna G Prajapati, Imran Ansari, Ganesh P Shah, Brian Wahl, Rama Kandasamy, Rahul Pradhan, Sarah Kelly, Merryn VoyseyDavid R Murdoch, Neelam Adhikari, Stephen Thorson, Dominic F Kelly, Shrijana Shrestha, Andrew J Pollard

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Invasive bacterial disease (IBD; including pneumonia, meningitis, sepsis) is a major cause of morbidity and mortality in children in low-income countries.

Methods
We analysed data from a surveillance study of suspected community-acquired IBD in children <15 years of age in Kathmandu, Nepal from 2005–2013 prior to introduction of pneumococcal conjugate vaccines (PCV). We detailed the serotype-specific distribution of invasive pneumococcal disease (IPD), and incorporated antigen and PCR testing of CSF from children with meningitis.

Results
Enhanced surveillance of IBD was undertaken during 2005–2006 and 2010–2013. During enhanced surveillance, a total of 7956 children were recruited of whom 7754 had blood and/or CSF culture results available for analysis, and 342 (4%) had a pathogen isolated. From 2007–2009 all 376 positive culture results were available, with 259 pathogens isolated (and 117 contaminants). Salmonella enterica serovar Typhi was the most prevalent pathogen isolated (167 cases, 28% of pathogens), followed by Streptococcus pneumoniae (98 cases, 16% pathogens). Approximately 73% and 78% of pneumococcal serotypes were contained in 10-valent and 13-valent PCV, respectively. Most cases of invasive pneumococcal disease (IPD) were among children ≥5 years of age from 2008 onwards. Antigen and PCR testing of CSF for pneumococci, Haemophilus influenzae type b and meningococci increased the number of these pathogens identified from 33 (culture) to 68 (culture/antigen/PCR testing).

Conclusions
S. enterica serovar Typhi and S. pneumoniae accounted for 44% of pathogens isolated. Most pneumococcal isolates were of serotypes contained in PCVs. Antigen and PCR testing of CSF improves sensitivity for IBD pathogens.
Original languageEnglish
JournalThe Pediatric infectious disease journal
Publication statusAccepted/In press - 2021

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