Bibek Khadka, Nepal
Patan Academy of Health Sciences Paediatric Research UnitPresenter of 1 Presentation
ASSOCIATION BETWEEN C-REACTIVE PROTEIN LEVEL AND A RADIOLOGICAL END POINT CONSOLIDATION PNEUMONIA AMONG HOSPITALISED CHILDREN WITH SUSPECTED PNEUMONIA IN NEPAL (ID 618)
- Bibek Khadka, Nepal
- Animesh Khulal, Nepal
- Sunaina Gurung, Nepal
- Meeru Gurung, Nepal
- Stephen Thorson, Nepal
- Shrijana Shrestha, Nepal
- Sanjeev M. Bijukchhe, Nepal
- Puja Amatya, Nepal
- Michael J. Carter, United Kingdom
- Matthew Smedley, United Kingdom
- Sarah Kelly, United Kingdom
- Kate M. Park, United Kingdom
- Merryn Voysey, United Kingdom
- David Murdoch, New Zealand
- Ganesh Shah, Nepal
- Maria Deloria Knoll, United States of America
- Dominic Kelly, United Kingdom
- Andrew J. Pollard, United Kingdom
Abstract
Background
S. pneumoniae is one of the most common causes of paediatric bacterial pneumonia. In low-income countries such as Nepal, CRP level and blood culture can be useful in diagnosis assessment. We assessed the association between CRP/blood culture, and pneumonia with end-point consolidation.
Methods
We included children less than 5 years of age admitted with suspected pneumonia to Patan Hospital in 2018 and 2019, whose chest xray, CRP level and blood culture were done. CRP levels >40 mg/dl were considered elevated.
Results
There was a significant difference (p<0.001) in CRP levels between EPC-pneumonia and non-EPC pneumonia cases with a median (IQR) CRP of 46.2 (16, 215) in 141 EPC-pneumonia cases and a median (IQR) CRP of 13 (4, 35) in non-EPC pneumonia cases. The sensitivity and specificity of CRP >40mg/dl to detect EPC pneumonia were 50% and 84% respectively. The area under the ROC curve was 0.727 indicating good discrimination between EPC-pneumonia and non-EPC pneumonia. Among the EPC-pneumonia cases, 62% had elevated CRP and 3.5% had S. pneumoniae positive blood cultures.
Conclusions
There was a significant association between CRP and EPC pneumonia. Blood culture had low sensitivity to detect bacterial pneumonia, nevertheless, CRP may be a useful tool in diagnosis of bacterial pneumonia.
Author Of 4 Presentations
IMPACT OF 10-VALENT PNEUMOCOCCAL CONJUGATE VACCINE INTRODUCTION ON INVASIVE PNEUMOCOCCAL DISEASE (IPD) IN NEPALESE CHILDREN (ID 563)
- Meeru Gurung, Nepal
- Merryn Voysey, United Kingdom
- Stephen Thorson, Nepal
- Sanjeev M. Bijukchhe, Nepal
- Peter J. O'Reilly, United Kingdom
- Michael J. Carter, United Kingdom
- Bibek Khadka, Nepal
- Animesh Khulal, Nepal
- Sunaina Gurung, Nepal
- Bhishma Pokhrel, Nepal
- Ganesh Shah, Nepal
- Imran Ansari, Nepal
- Sarah Kelly, United Kingdom
- Dominic Kelly, United Kingdom
- David Murdoch, New Zealand
- Andrew J. Pollard, United Kingdom
- Shrijana Shrestha, Nepal
Abstract
Background
We assessed the distribution of pneumococcal serotypes in children with microbiologically-confirmed invasive pneumococcal disease (IPD) before (2014-2015) and after (2016-2019) PCV10 introduction in Nepal in 2015.
Methods
Children (aged 2 months to <14 years) admitted to Patan Hospital, Nepal with pneumococcus detected in blood, CSF or pleural fluid were included. Serotyping was by Quellung method.
Results
Pre-vaccine, 6/22 (27.3%) IPD cases were age <2 years; post-vaccine, 5/36 (13.9%) were <2 years. Ratio of vaccine-type to non-vaccine-type IPD among <2y olds was 5:1 pre-vaccine and 2:3 post-vaccine; among >=2y olds, the ratio was 13:1 pre-vaccine and 7:1 post-vaccine. Most (32/41, 78%) vaccine-type IPD was serotype 1: 3/7 among <2 year olds (n=1 post-vaccine); 29/34 among >=2 year olds (n=17/19 post-vaccine were >4 years old). Among 44 IPD cases detected from blood, 36 (82%) were vaccine-type (n=29 were ST1), and 7 were non-vaccine-type (6C, 10A (n=2), 19A, 24F, 38, 41). Of 13 detected from CSF (1 culture, 3 PCR and 9 Binax-only), 5 were serotyped (1, 14, 6B, 6A/B, 7F) .The 3 pleural fluid cases were serotypes 1 (n=2) and 19A.
Conclusions
Post-PCV10 introduction, IPD among <2 year olds fell; although a high proportion of ST1 IPD remains, most were >4 years old.
THE IMPACT OF PNEUMOCOCCAL CONJUGATE VACCINE INTRODUCTION IN NEPAL: A SIX-YEAR PAEDIATRIC SURVEILLANCE STUDY (ID 516)
- Shrijana Shrestha, Nepal
- Meeru Gurung, Nepal
- Stephen Thorson, Nepal
- Bhishma Pokhrel, Nepal
- Bibek Khadka, Nepal
- Pratistha Maskey, Nepal
- Puja Amatya, Nepal
- Madhav C. Gautam, Nepal
- Michael J. Carter, United Kingdom
- Rama Kandasamy, Australia
- Brian Wahl, United States of America
- Sarah Kelly, United Kingdom
- Krishna G. Prajapati, Nepal
- Sonu Shrestha, United Kingdom
- Maria Deloria Knoll, United States of America
- Jason Hinds, United Kingdom
- Ganesh Shah, Nepal
- Dominic Kelly, United Kingdom
- David Murdoch, New Zealand
- Merryn Voysey, United Kingdom
- Andrew J. Pollard, United Kingdom
Abstract
Background
S. pneumoniae is a major cause of bacterial pneumonia and an important cause of invasive bacterial disease (IBD) in children under-five years of age in Nepal. Pneumococcal conjugate vaccine, PCV10, was introduced in 2015 with a 2+1 schedule.
Methods
We assessed the programmatic impact of PCV10 introduction using surveillance for nasopharyngeal (NP) colonisation, pneumonia and IBD. NP swabs from pneumonia inpatients and from healthy children, blood cultures from inpatients with suspected IBD, and chest x-rays from inpatient pneumonia cases were obtained over a 6-year period (2014-2019).
Results
The proportion of pneumonia cases with radiographic endpoint-consolidation (likely bacterial) was 34% lower (95%CI 19-46%) in 2018 compared with the pre-vaccine period (2014-2015). Vaccine serotype (VT) carriage in children under 2-years of age with pneumonia in 2019 was 78% lower (95%CI 30-93%) than in the pre-vaccine period.
Among healthy 6-23 month old children (urban and rural cohorts), VT-carriage declined 74% (95%CI 43-82%) by 2019. An increase in PCV13-additional-serotype carriage was seen in 2018 among rural-children (prevalence-ratio 1.65, 95%CI 1.17-2.32), but not urban-children.
Serotype 1 remains the dominant serotype detected in cases of invasive pneumococcal disease.
Conclusions
A decrease in prevalence of endpoint-consolidation-pneumonia and a decrease in vaccine-serotype circulation have been observed post PCV introduction in Nepal.
ASSOCIATION BETWEEN C-REACTIVE PROTEIN LEVEL AND A RADIOLOGICAL END POINT CONSOLIDATION PNEUMONIA AMONG HOSPITALISED CHILDREN WITH SUSPECTED PNEUMONIA IN NEPAL (ID 618)
- Bibek Khadka, Nepal
- Animesh Khulal, Nepal
- Sunaina Gurung, Nepal
- Meeru Gurung, Nepal
- Stephen Thorson, Nepal
- Shrijana Shrestha, Nepal
- Sanjeev M. Bijukchhe, Nepal
- Puja Amatya, Nepal
- Michael J. Carter, United Kingdom
- Matthew Smedley, United Kingdom
- Sarah Kelly, United Kingdom
- Kate M. Park, United Kingdom
- Merryn Voysey, United Kingdom
- David Murdoch, New Zealand
- Ganesh Shah, Nepal
- Maria Deloria Knoll, United States of America
- Dominic Kelly, United Kingdom
- Andrew J. Pollard, United Kingdom
Abstract
Background
S. pneumoniae is one of the most common causes of paediatric bacterial pneumonia. In low-income countries such as Nepal, CRP level and blood culture can be useful in diagnosis assessment. We assessed the association between CRP/blood culture, and pneumonia with end-point consolidation.
Methods
We included children less than 5 years of age admitted with suspected pneumonia to Patan Hospital in 2018 and 2019, whose chest xray, CRP level and blood culture were done. CRP levels >40 mg/dl were considered elevated.
Results
There was a significant difference (p<0.001) in CRP levels between EPC-pneumonia and non-EPC pneumonia cases with a median (IQR) CRP of 46.2 (16, 215) in 141 EPC-pneumonia cases and a median (IQR) CRP of 13 (4, 35) in non-EPC pneumonia cases. The sensitivity and specificity of CRP >40mg/dl to detect EPC pneumonia were 50% and 84% respectively. The area under the ROC curve was 0.727 indicating good discrimination between EPC-pneumonia and non-EPC pneumonia. Among the EPC-pneumonia cases, 62% had elevated CRP and 3.5% had S. pneumoniae positive blood cultures.
Conclusions
There was a significant association between CRP and EPC pneumonia. Blood culture had low sensitivity to detect bacterial pneumonia, nevertheless, CRP may be a useful tool in diagnosis of bacterial pneumonia.
IMPACT OF PNEUMOCOCCAL CONJUGATE VACCINE (PCV-10) ON RADIOLOGICAL PNEUMONIA AT A TERTIARY CARE CENTRE IN NEPAL (ID 514)
- Puja Amatya, Nepal
- Michael J. Carter, United Kingdom
- Matthew Smedley, United Kingdom
- Meeru Gurung, Nepal
- Sarah Kelly, United Kingdom
- Merryn Voysey, United Kingdom
- David Murdoch, New Zealand
- Ganesh Shah, Nepal
- Stephen Thorson, Nepal
- Shrijana Shrestha, Nepal
- Bibek Khadka, Nepal
- Animesh K. Basnet, Nepal
- Sunaina Gurung, Nepal
- Maria D. Knoll, United States of America
- Dominic Kelly, United Kingdom
- Andrew J. Pollard, United Kingdom
- Kate M. Park, United Kingdom
Abstract
Background
Routine immunization with 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in Kathmandu in 2015 with doses administered at 6 weeks, 10 weeks and 9 months of age. We assessed the impact of PCV10 on the prevalence of radiographic changes in children aged 2 months to 14 years with a clinical diagnosis of pneumonia admitted to Patan Hospital, Kathmandu.
Methods
Digitalized chest radiographs were interpreted using standardized WHO criteria as primary endpoint pneumonia (PEP), other infiltrate or normal, by two specific readers. A third reader arbitrated upon all discordant results.
Results
From March 2014 to December 2018, 1755 children were enrolled, of whom 1692 (96%) had interpretable radiographs. The proportion of children with PEP decreased annually from 84/189 (44%) in 2014 to 105/414 (25%) in 2018 (p<0.001). PEP was associated with age, occurring in 247/1090 (22%) children <2 years of age, in comparison with 120/175 (69%) children ≥5 years of age (p<0.001), and carriage of PCV10 serotypes, occurring in 95/188 (51%) children with PCV10 carriage in comparison with 459/1504 (31%) children with non-PCV10 serotypes or no carriage (p<0.001).
Conclusions
The prevalence of PEP in children hospitalized with pneumonia decreased from 2014 to 2018 in association with the implementation of PCV10 immunization in Kathmandu.