Maria Deloria Knoll, United States of America
Johns Hopkins Bloomberg School of Health International Vaccine Access Centre, International HealthAuthor Of 7 Presentations
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.
COMPARISON OF NASOPHARYNGEAL CARRIAGE OF PNEUMOCOCCUS AND ITS SEROTYPES AMONG NEPALI CHILDREN HOSPITALIZED WITH SEVERE AND NON-SEVERE PNEUMONIA (ID 764)
- Animesh Khulal, Nepal
- Meeru Gurung, Nepal
- Sanjeev M. Bijukchhe, Nepal
- Peter J. O'Reilly, United Kingdom
- Sunaina Gurung, Nepal
- Sonu K. Yadav, Nepal
- Stephen Thorson, Nepal
- Bhishma Pokhrel, Nepal
- Ganesh Shah, Nepal
- Imran Ansari, Nepal
- Sarah Kelly, United Kingdom
- Merryn Voysey, United Kingdom
- Maria Deloria Knoll, United States of America
- Dominic Kelly, United Kingdom
- David Murdoch, New Zealand
- Andrew J. Pollard, United Kingdom
- Shrijana Shrestha, Nepal
NASOPHARYNGEAL CARRIAGE PREVALENCE OF SEROTYPES 3, 6A, 19A AND 6C IN NEPALESE CHILDREN: IS IT TIME TO SWITCH FROM PCV10 TO A DIFFERENT PCV? (ID 528)
- Pratistha Maskey, Nepal
- Meeru Gurung, Nepal
- Sanjeev M. Bijukchhe, Nepal
- Peter J. O'Reilly, United Kingdom
- Himang M. Maskey, Nepal
- Subhash Shrestha, Nepal
- Stephen Thorson, Nepal
- Madhav C. Gautam, Nepal
- Bhishma Pokhrel, Nepal
- Ganesh Shah, Nepal
- Imran Ansari, Nepal
- Sarah Kelly, United Kingdom
- Merryn Voysey, United Kingdom
- Maria Deloria Knoll, United States of America
- Dominic Kelly, United Kingdom
- David Murdoch, New Zealand
- Andrew J. Pollard, United Kingdom
- Shrijana Shrestha, Nepal
IMPACT OF NUMBER OF CHILDREN IN THE HOUSEHOLD ON NASOPHARYNGEAL CARRIAGE OF STREPTOCOCCUS PNEUMONIAE IN HEALTHY NEPALESE CHILDREN (ID 534)
- Himang M. Maskey, Nepal
- Meeru Gurung, Nepal
- Sanjeev M. Bijukchhe, Nepal
- Peter J. O'Reilly, United Kingdom
- Pratistha Maskey, Nepal
- Subhash Shrestha, Nepal
- Madhav C. Gautam, Nepal
- Stephen Thorson, Nepal
- Bhishma Pokhrel, Nepal
- Ganesh Shah, Nepal
- Imran Ansari, Nepal
- Sarah Kelly, United Kingdom
- Merryn Voysey, United Kingdom
- Maria Deloria Knoll, United States of America
- Dominic Kelly, United Kingdom
- David Murdoch, New Zealand
- Andrew J. Pollard, United Kingdom
- Shrijana Shrestha, Nepal
IS THERE A RELATIONSHIP BETWEEN PREVIOUS HISTORY OF PNEUMONIA, MENINGITIS OR SEPSIS AND NASOPHARYNGRAL CARRIAGE OF STREPTOCOCCUS PNEUMONIAE IN HEALTHY CHILDREN IN NEPAL (ID 752)
- Himang M. Maskey, Nepal
- Meeru Gurung, Nepal
- Sanjeev M. Bijukchhe, Nepal
- Peter J. O'Reilly, United Kingdom
- Pratistha Maskey, Nepal
- Subhash Shrestha, Nepal
- Stephen Thorson, Nepal
- Bhishma Pokhrel, Nepal
- Ganesh Shah, Nepal
- Imran Ansari, Nepal
- Sarah Kelly, United Kingdom
- Merryn Voysey, United Kingdom
- Maria Deloria Knoll, United States of America
- Dominic Kelly, United Kingdom
- David Murdoch, New Zealand
- Andrew J. Pollard, United Kingdom
- Shrijana Shrestha, Nepal
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.
IMPACT OF PCV10 INTRODUCTION ON NASOPHARYNGEAL CARRIAGE OF STREPTOCOCCUS PNEUMONIAE IN HEALTHY CHILDREN IN RURAL AND URBAN NEPAL (ID 531)
- Madhav Chandra Gautam, Nepal
- Sonu Shrestha, United Kingdom
- Sanjeev M. Bijukchhe, Nepal
- Meeru Gurung, Nepal
- Bhishma Pokhrel, Nepal
- Merryn Voysey, United Kingdom
- Peter J. O'Reilly, United Kingdom
- Sarah Kelly, United Kingdom
- Ganesh Shah, Nepal
- Laxmi Lama, Nepal
- Pratistha Maskey, Nepal
- Stephen Thorson, Nepal
- David Murdoch, New Zealand
- Maria Deloria Knoll, United States of America
- Dominic Kelly, United Kingdom
- Shrijana Shrestha, Nepal
- Andrew J. Pollard, United Kingdom
Abstract
Background
The ten-valent pneumococcal conjugate vaccine (PCV10) was introduced in Nepal in 2015. We compared the nasopharyngeal carriage of PCV10 and non-PCV10 serotypes of pneumococcus between pre-vaccine (2015) and post-vaccine (2017-2018) years in two different regions of Nepal.
Methods
Nasopharyngeal samples obtained in healthy Nepalese children aged 6-59 months in urban (Patan, Kathmandu) and 6-23 months in rural (Okhaldhunga) settings were transported in STGG (Skim Milk-Tryptone-Glucose-Glycerol) media, cultured for pneumococcus and serotyped by the Quellung method.
Results
The carriage prevalence decreased for all PCV10-type serotypes except 7F in both the settings. PCV10-type prevalence decreased from 29.7% in rural and 17.2% in urban children pre-vaccine to 9.0% and 8.6% post-vaccine, respectively. Pre-vaccine, the most frequently found serotypes in both settings were 19F, 6B, 14. Post-vaccine, the non-PCV10 serotypes were more common; serotypes 34, 6C, 19A and 15B were most common in rural and 6A, 34, 11A, 6C and 15B in urban settings.
Conclusions
Since the introduction of PCV10, carriage prevalence of PCV10 serotypes have reduced and non-PCV10 serotypes have increased in both settings raising the possibility of replacement disease. Continued monitoring of changes in PCV10-serotypes and non-PCV10 serotypes, especially those covered by PCV13, is important to assess vaccine impact.