Nevio D. Sarmento, Timor-Leste

Menzies School of Health Research, Timor-Leste Office Global and Tropical Health Division

Presenter of 1 Presentation

THE EFFECT OF ANTIBIOTIC USE ON NASOPHARYNGEAL CARRIAGE OF S. PNEUMONIAE IN A SURVEILLANCE STUDY OF HOSPITALISED CHILDHOOD PNEUMONIA AND MALNUTRITION IN DILI, TIMOR-LESTE (ID 1029)

Abstract

Background

Hospital-based surveillance of pneumonia is an emerging method for monitoring pneumococcal conjugate vaccine (PCV) effectiveness, especially in low resource settings like Timor-Leste. We assessed the impact of antibiotic use on nasopharyngeal carriage of S. pneumoniae (SPN).

Methods

Pulmaun Saudavel is an ongoing pre-PCV surveillance study of children 1-59 months hospitalised with pneumonia and/or malnutrition. Nasopharyngeal swabs were collected as soon as practical after admission and cultured. Antibiotic exposure was classified as prehospital (by parent report) and in-hospital (from the medical record).

Results

Of 160 cases enrolled between September 2019 and January 2020, 43 (26%) had NP carriage of SPN. Carriage was higher among cases without any antibiotic exposure (15/27, 56%), compared to those with any antibiotic exposure (28/133, 21%; p<0.01). While there was no difference in carriage between those with and without prehospital exposure (24% vs 30%, p=0.39), those with swab collected <12hrs after in-hospital exposure had higher carriage compared to those with swab collected >12hrs (50% vs 19%, p=0.034). This remained significant in a logistic regression adjusted for age and sex (p=0.047).

Conclusions

Antibiotic exposure is associated with reduced NP carriage of SPN. Hospital-based studies should attempt to collect NP swabs within 12 hours of first antibiotic dose.

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Author Of 4 Presentations

THE EFFECT OF ANTIBIOTIC USE ON NASOPHARYNGEAL CARRIAGE OF S. PNEUMONIAE IN A SURVEILLANCE STUDY OF HOSPITALISED CHILDHOOD PNEUMONIA AND MALNUTRITION IN DILI, TIMOR-LESTE (ID 1029)

Abstract

Background

Hospital-based surveillance of pneumonia is an emerging method for monitoring pneumococcal conjugate vaccine (PCV) effectiveness, especially in low resource settings like Timor-Leste. We assessed the impact of antibiotic use on nasopharyngeal carriage of S. pneumoniae (SPN).

Methods

Pulmaun Saudavel is an ongoing pre-PCV surveillance study of children 1-59 months hospitalised with pneumonia and/or malnutrition. Nasopharyngeal swabs were collected as soon as practical after admission and cultured. Antibiotic exposure was classified as prehospital (by parent report) and in-hospital (from the medical record).

Results

Of 160 cases enrolled between September 2019 and January 2020, 43 (26%) had NP carriage of SPN. Carriage was higher among cases without any antibiotic exposure (15/27, 56%), compared to those with any antibiotic exposure (28/133, 21%; p<0.01). While there was no difference in carriage between those with and without prehospital exposure (24% vs 30%, p=0.39), those with swab collected <12hrs after in-hospital exposure had higher carriage compared to those with swab collected >12hrs (50% vs 19%, p=0.034). This remained significant in a logistic regression adjusted for age and sex (p=0.047).

Conclusions

Antibiotic exposure is associated with reduced NP carriage of SPN. Hospital-based studies should attempt to collect NP swabs within 12 hours of first antibiotic dose.

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NASOPHARYNGEAL CARRIAGE OF S. PNEUMONIAE IN CHILDREN SEVERE ACUTE MALNUTRITION (SAM) AND/OR PNEUMONIA: PRELIMINARY FINDINGS FROM A SURVEILLANCE PROJECT AT THE DILI NATIONAL HOSPITAL, TIMOR-LESTE (ID 1172)

Abstract

Background

Children with SAM have impaired immune function (including mucosal defences) and an increased risk of pneumococcal pneumonia. We evaluated if SAM was associated with increased nasopharyngeal carriage of S. pneumoniae (Spn).

Methods

Pulmaun Saudavel is an ongoing surveillance study of children aged 1-59 months hospitalised with SAM and/or pneumonia in Dili, Timor-Leste, where no pneumococcal conjugate vaccine (PCV) is in use. SAM is defined according to World Health Organization (WHO) criteria. Pneumonia is defined as cough or difficulty breathing and any one of: respiratory rate >50bpm, oxygen saturation <90%, lower chest wall indrawing, or WHO-defined radiological pneumonia. NP swabs are collected after admission and processed according to WHO guidelines.

Results

Of 160 cases enrolled to date, 103 (64%) had pneumonia, 27 (17%) SAM, and 30 (19%) both pneumonia and SAM. Overall NP carriage of Spn was 27% (43/160). There was no difference in carriage between SAM cases (15/57, 26%) and pneumonia-only cases (27/97, 28%). Among children with SAM, those with pneumonia had higher carriage (11/30, 37%) compared to those without pneumonia (4/27, 15%; p=0.08).

Conclusions

Pneumonia is a common complication of SAM and may be associated with increased Spn carriage. PCV use in Timor-Leste is likely to benefit children with SAM.

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CLINICAL FEATURES OF PNEUMONIA IN CHILDREN WITH AND WITHOUT SEVERE ACUTE MALNUTRITION (SAM): PRELIMINARY FINDINGS FROM A SURVEILLANCE PROJECT AT THE DILI NATIONAL HOSPITAL, TIMOR-LESTE (ID 679)

Abstract

Background

SAM is a significant risk factor for pneumonia, but pneumonia can be hard to diagnose in children with SAM. We aimed to assess differences in clinical findings of pneumonia cases with and without SAM.

Methods

Pulmaun Saudavel is an ongoing surveillance study of children aged 1-59 months hospitalised with pneumonia and/or SAM in Dili, Timor-Leste. Pneumonia was defined as cough or difficulty breathing and any one of: respiratory rate >50bpm, oxygen saturation <90%, lower chest wall indrawing (LCWI), or World Health Organization(WHO)-defined radiological pneumonia. SAM was defined according to WHO criteria.

Results

Of 160 children enrolled between September 2019 and January 2020, 103 (64%) had pneumonia, 27 (17%) SAM, and 30 (19%) both pneumonia and SAM. Two children died, both with pneumonia and SAM. Compared to pneumonia-only cases, children with pneumonia and SAM more frequently met enrolment criteria because of radiological pneumonia (54% vs 42%) and less frequently for LCWI (48% vs 62%), and had more lethargy (43% vs 25%), and vomiting (17% vs 8%; all p>0.05). No differences were found for tachypnoea, hypoxemia, or auscultation findings.

Conclusions

Pneumonia is common in SAM. While LCWI is used in many pneumonia guidelines, it may not be as useful for children with SAM.

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IMPACT OF A SINGLE DOSE OF PCV10 OR PCV13 ON NASOPHARYNGEAL PNEUMOCOCCAL CARRIAGE IN VIETNAMESE CHILDREN DURING THE FIRST YEAR OF LIFE (ID 696)

Abstract

Background

Reduced-dose schedules of pneumococcal conjugate vaccine (PCV) could increase the accessibility and use of PCV in low and middle-income countries.

Methods

Groups within the Vietnam Pneumococcal Trial II receive PCV10 and PCV13 in a 1+1 schedule at 2 and 12 months of age, or no vaccine. Nasopharyngeal swabs were collected at 6 and 12 months of age to show the impact of the 2-month dose on pneumococcal carriage.

Results

Based on analysis to date of 1152 of 3200 swabs, vaccine-type carriage was low. In unvaccinated participants, PCV10 and PCV13-type carriage were 5.1% and 10.4% at 6 months, and 8.3% and 12.0% at 12 months, respectively. A dose of PCV10 transiently reduced vaccine-type carriage at 6 months of age (3/178 [1.7%] versus 18/355 [5.1%]).

Conclusions

With the exception of the PCV10 group at 6 months of age, both vaccine-type and non-vaccine-type carriage rates were similar among PCV10-vaccinated participants, PCV13-vaccinated participants and unvaccinated controls at 6 and 12 months of age. Based on preliminary data, a single dose of PCV at 2 months of age does not appear to reduce pneumococcal carriage during the first year of life in this population.

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