TY - JOUR
T1 - Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA)
T2 - an observational cohort study
AU - Saha, Samir K.
AU - Schrag, Stephanie J.
AU - El Arifeen, Shams
AU - Mullany, Luke C.
AU - Shahidul Islam, Mohammad
AU - Shang, Nong
AU - Qazi, Shamim A.
AU - Zaidi, Anita K.M.
AU - Bhutta, Zulfiqar A.
AU - Bose, Anuradha
AU - Panigrahi, Pinaki
AU - Soofi, Sajid B.
AU - Connor, Nicholas E.
AU - Mitra, Dipak K.
AU - Isaac, Rita
AU - Winchell, Jonas M.
AU - Arvay, Melissa L.
AU - Islam, Maksuda
AU - Shafiq, Yasir
AU - Nisar, Imran
AU - Baloch, Benazir
AU - Kabir, Furqan
AU - Ali, Murtaza
AU - Diaz, Maureen H.
AU - Satpathy, Radhanath
AU - Nanda, Pritish
AU - Padhi, Bijaya K.
AU - Parida, Sailajanandan
AU - Hotwani, Aneeta
AU - Hasanuzzaman, M.
AU - Ahmed, Sheraz
AU - Belal Hossain, Mohammad
AU - Ariff, Shabina
AU - Ahmed, Imran
AU - Ibne Moin, Syed Mamun
AU - Mahmud, Arif
AU - Waller, Jessica L.
AU - Rafiqullah, Iftekhar
AU - Quaiyum, Mohammad A.
AU - Begum, Nazma
AU - Balaji, Veeraraghavan
AU - Halen, Jasmin
AU - Nawshad Uddin Ahmed, A. S.M.
AU - Weber, Martin W.
AU - Hamer, Davidson H.
AU - Hibberd, Patricia L.
AU - Sadeq-ur Rahman, Qazi
AU - Mogan, Venkat Raghava
AU - Hossain, Tanvir
AU - McGee, Lesley
AU - Anandan, Shalini
AU - Liu, Anran
AU - Panigrahi, Kalpana
AU - Abraham, Asha Mary
AU - Baqui, Abdullah H.
N1 - Publisher Copyright:
© 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2018/7/14
Y1 - 2018/7/14
N2 - Background: More than 500 000 neonatal deaths per year result from possible serious bacterial infections (pSBIs), but the causes are largely unknown. We investigated the incidence of community-acquired infections caused by specific organisms among neonates in south Asia. 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.
AB - Background: More than 500 000 neonatal deaths per year result from possible serious bacterial infections (pSBIs), but the causes are largely unknown. We investigated the incidence of community-acquired infections caused by specific organisms among neonates in south Asia. 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.
UR - http://www.scopus.com/inward/record.url?scp=85053736763&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(18)31127-9
DO - 10.1016/S0140-6736(18)31127-9
M3 - Article
C2 - 30025808
AN - SCOPUS:85053736763
SN - 0140-6736
VL - 392
SP - 145
EP - 159
JO - The Lancet
JF - The Lancet
IS - 10142
ER -