Incidence of clinically significant bacteraemia in children who present to hospital in Kenya: Community-based observational study

Department of Paediatrics, University of Oxford, Oxford, England, United Kingdom
The Lancet (Impact Factor: 45.22). 03/2006; 367(9509):482-8. DOI: 10.1016/S0140-6736(06)68180-4
Source: PubMed


Estimates of the burden of invasive bacterial disease in sub-Saharan Africa have previously relied on selected groups of patients, such as inpatients; they are, therefore, probably underestimated, potentially hampering vaccine implementation. Our aim was to assess the incidence of bacteraemia in all children presenting to a hospital in Kenya, irrespective of clinical presentation or decision to admit.
We did a community-based observational study for which we cultured blood from 1093 children who visited a Kenyan hospital outpatient department. We estimated bacteraemia incidence with a Demographic Surveillance System, and investigated the clinical significance of bacteraemia and the capacity of clinical signs to identify cases.
The yearly incidence of bacteraemia per 100,000 children aged younger than 2 years and younger than 5 years was 2440 (95% CI 1307-3573) and 1192 (692-1693), respectively. Incidence of pneumococcal bacteraemia was 597 (416-778) per 100,000 person-years of observation in children younger than age 5 years. Three-quarters of episodes had a clinical focus or required admission, or both; one in six was fatal. After exclusion of children with occult bacteraemia, the incidence of clinically significant bacteraemia per 100,000 children younger than age 2 years or 5 years fell to 1741 (790-2692) and 909 (475-1343), respectively, and the yearly incidence of clinically significant pneumococcal bacteraemia was 436 (132-739) per 100,000 children younger than 5 years old. Clinical signs identified bacteraemia poorly.
Clinically significant bacteraemia in children in Kilifi is twice as common, and pneumococcal bacteraemia four times as common, as previously estimated. Our data support the introduction of pneumococcal vaccine in sub-Saharan Africa.

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Available from: Mike English, Aug 17, 2015
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    • "us ( SES ) groups ( Q1 = low SES and Q4 = high SES ) . doi : 10 . 1371 / journal . pone . 0139433 . g003 Urbanicity and Bacteraemia PLOS ONE | DOI : 10 . 1371 / journal . pone . 0139433 September 29 , 2015 8 / 11 We detected bacteraemia in 3 . 1% of febrile OPD children , a frequency similar to that in other OPD studies from sub - Saharan Africa . Brent et al . ( 2006 ) reported a rate of 2% in paedi - atric outpatients in Kenya [ 20 ] and Thriemer et al . ( 2012 ) reported a rate of 4% in outpatients of all ages in Zanzibar [ 21 ] . Yet , case numbers in our study were too small to assess effects at pathogen level apart from NTS . It remains unclear whether NTS was the main pathogen associ - ated wi"

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    • "This vaccination programme would thus be expected to impact upon the pneumococcal serotypes implicated in PCAP. Pathogens are difficult to identify in children with pneumonia, with blood culture and serological testing often negative due to minimal presence of bacteremia (Brent et al., 2006; Korppi et al., 2008). This paucity of S. pneumoniae isolation makes examining pneumococcal serotype distribution in PCAP difficult, with no UK, and little worldwide, data. "
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    • "Consistent with at least one other study, we found that bacteraemia was uncommon in children with non-severe illness, especially in children who were RDT-positive [27]. However, blood culture lacks sensitivity and early recognition and treatment of blood stream infections has the potential to avert progression to severe disease with high associated mortality [14,28]. "
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