Severe Lower Respiratory Tract Infection in Early Infancy and Pneumonia Hospitalizations among Children, Kenya - Vol. 19 No. 2 - February 2013 - Emerging Infectious Disease journal - CDC

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Severe Lower Respiratory Tract Infection in Early Infancy and Pneumonia Hospitalizations among Children, Kenya - Vol. 19 No. 2 - February 2013 - Emerging Infectious Disease journal - CDC

Table of Contents
Volume 19, Number 2– February 2013

Volume 19, Number 2—February 2013

Research

Severe Lower Respiratory Tract Infection in Early Infancy and Pneumonia Hospitalizations among Children, Kenya

Article Contents

• Methods
• Study Population
• Results
• Discussion
• Acknowledgments
• References
• Figure 1
• Figure 2
• Table 1
• Table 2
• Technical Appendix  [104 KB - 2 pages]
• Suggested Citation

Patrick Kiio Munywoki , Eric O. Ohuma, Mwanajuma Ngama, Evasius Bauni, J. Anthony G. Scott, and D. James Nokes

Author affiliations: Author affiliations: KEMRI-Wellcome Trust Research Programme Centre for Geographic Medicine Research–Coast, Kilifi, Kenya (P.K. Munywoki, E.O. Ohuma, M. Ngama, E. Bauni, J.A.G. Scott, D.J. Nokes); University of Oxford, Oxford, UK (E.O. Ohuma, J.A.G. Scott); University of Warwick, Coventry, UK (D.J. Nokes)

Suggested citation for this article

Abstract

Severe lower respiratory tract infection (LRTI) in infants caused by respiratory syncytial virus (RSV) has been associated with later pneumonia hospitalization among children. To determine risk for pneumonia after RSV hospitalization in infancy, we conducted a retrospective cohort analysis of 2,813 infants admitted to a hospital in Kenya and identified readmissions for pneumonia among this group during early childhood (<60 months of age). Incidence of readmission for pneumonia was higher for children whose first admission as infants was for LRTI and who were <3 months of age than for children who were first admitted as infants for non-LRTI, irrespective of RSV status. Incidence of readmission for pneumonia with wheeze was higher for children whose first admission involved RSV compared with those who had non-RSV LRTI. Excess pneumonia risk persisted for 2 years after the initial hospitalization. Close postdischarge follow-up of infants with LRTI, with or without RSV, could help prevent severe pneumonia later in childhood.

Pneumonia is a major cause of illness and death among children <5 a="" africa="" age="" href="http://wwwnc.cdc.gov/eid/article/19/2/12-0940_article.htm?s_cid=eid-gDev-email#r1" in="" of="" sub-saharan="" title="1" years="">1
,2), and respiratory syncytial virus (RSV) is the most common viral cause of pneumonia and bronchiolitis in this age group (3,4). RSV infection in infancy is associated with other long-term respiratory problems (5–10) and, in one study, with pneumonia (11). The magnitude and duration of the increased risk for pneumonia after RSV infection are poorly defined (12). In addition, it is not clear whether this association is specific to RSV or whether other causes of lower respiratory tract infection (LRTI) in infancy are also associated with later pneumonia (11). A study in The Gambia reported an increased incidence of hospital admission for pneumonia, measurable up to 3 years after discharge (11). We report results of a retrospective cohort analysis of children admitted to a rural district hospital in Kenya using data from a prospective longitudinal clinical surveillance project nested within a health and demographic surveillance system (13). The cohort was defined as all infants admitted to the hospital during 9 RSV seasons during 2002–2010; the infants were classified into exposure groups on the basis of the clinical features of LRTI and laboratory diagnosis of RSV at the first admission. The main outcome was readmission to a hospital for pneumonia before the age of 5 years.