Katherine E. Gallagher, United Kingdom

London School of Hygiene and Tropical Medicine Epidemiology and Population Health

Presenter of 1 Presentation

 Conference Calendar

CHILDREN ADMITTED TO HOSPITAL WITH LOWER-CHEST-WALL INDRAWING PNEUMONIA IN SEVEN LOW AND MIDDLE-INCOME COUNTRIES: WHO DIED AND WHO SURVIVED? (ID 758)

Session Name
Clinical Sciences - Treatment of Pneumococcal Disease in Infants, Children/Youth, and Adults
Presenter
Authors

Abstract

Background

In 2013, to increase effective distribution of antibiotics, WHO revised treatment guidelines for childhood pneumonia with lower chest wall indrawing (LCWI) to recommend home-based-treatment with oral antibiotics rather than hospital-based management. We analysed the implications of this policy in the PERCH study, where all children were hospitalised.

Methods

In PERCH, 2113 children aged 2-59 months were admitted with LCWI pneumonia between 2011-2014 in Kenya, Zambia, South Africa, Mali, The Gambia, Bangladesh and Thailand. We analysed their mortality risk, and risk factors for mortality using logistic regression.

Results

Among cases with LCWI pneumonia, 76 (3.6%) died in hospital or within 7 days of discharge. Factors associated with fatal outcome included age (aOR 2.03 (95%CI 1.05-3.93) for infants vs older children), absence of cough, oxygen saturation (80-91% oxygen aOR 2.04 (1.07-3.90), <80% aOR 6.51 (2.82-15.0)), low anthropometric scores and HIV exposure.

Conclusions

Despite hospital admission, 3.6% of children with LCWI pneumonia died; mortality may be higher among similar children if treated in the community. Among children with LCWI pneumonia presenting to hospital, selective admission for those who also have hypoxia, features of malnutrition and young age may ensure that those with the greatest risk of death receive optimal supportive therapy.

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Author Of 2 Presentations

 Conference Calendar

PNEUMOCOCCAL CONJUGATE VACCINE DOSE-RANGING STUDIES IN HUMANS: A SYSTEMATIC REVIEW (ID 268)

Session Name
Vaccines - Pneumococcal Vaccines Development
Presenter
Authors

Abstract

Background

Reduced dose vaccination with pneumococcal conjugate vaccines may protect against infection. We sought to examine the relationship between the dose of polysaccharide in conjugate vaccines (PCVs) and immunogenicity.

Methods

A systematic review of English publications that evaluated variable dose immunogenicity of PCVs in humans was performed in Medline and Embase databases (Ovid SP) in August 2019. Results were synthesised descriptively due to the heterogeneity of product valency, content and vaccine schedule.

Results

We identified 1691 articles after de-duplication; 9 studies met our inclusion criteria; 2 in adults, 6 in children and 1 in both. Doses of polysaccharide evaluated ranged from 0.44 mcg to 17.6 mcg. Thirty days after vaccination following a single dose or 2p+1 schedule, all doses tested in infants achieved mean IgG concentrations (GMCs) above the acceptable correlate of protection (COP; 0.35 mcg) and only three GMCs' 95% confidence intervals crossed the COP. All doses tested in adults achieved GMCs that were comparable to those considered protective in children who have received 3 standard vaccine doses.

Conclusions

For some products, the mean antibody concentrations induced for some pneumococcal serotypes increased with increasing doses of the polysaccharide but the functional significance of these is uncertain.

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CHILDREN ADMITTED TO HOSPITAL WITH LOWER-CHEST-WALL INDRAWING PNEUMONIA IN SEVEN LOW AND MIDDLE-INCOME COUNTRIES: WHO DIED AND WHO SURVIVED? (ID 758)

Session Name
Clinical Sciences - Treatment of Pneumococcal Disease in Infants, Children/Youth, and Adults
Presenter
Authors

Abstract

Background

In 2013, to increase effective distribution of antibiotics, WHO revised treatment guidelines for childhood pneumonia with lower chest wall indrawing (LCWI) to recommend home-based-treatment with oral antibiotics rather than hospital-based management. We analysed the implications of this policy in the PERCH study, where all children were hospitalised.

Methods

In PERCH, 2113 children aged 2-59 months were admitted with LCWI pneumonia between 2011-2014 in Kenya, Zambia, South Africa, Mali, The Gambia, Bangladesh and Thailand. We analysed their mortality risk, and risk factors for mortality using logistic regression.

Results

Among cases with LCWI pneumonia, 76 (3.6%) died in hospital or within 7 days of discharge. Factors associated with fatal outcome included age (aOR 2.03 (95%CI 1.05-3.93) for infants vs older children), absence of cough, oxygen saturation (80-91% oxygen aOR 2.04 (1.07-3.90), <80% aOR 6.51 (2.82-15.0)), low anthropometric scores and HIV exposure.

Conclusions

Despite hospital admission, 3.6% of children with LCWI pneumonia died; mortality may be higher among similar children if treated in the community. Among children with LCWI pneumonia presenting to hospital, selective admission for those who also have hypoxia, features of malnutrition and young age may ensure that those with the greatest risk of death receive optimal supportive therapy.

Hide