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O002 - PATHOGEN-SPECIFIC CAUSES OF PNEUMONIA DEATHS IN CHILDREN 1-59 MONTHS DETERMINED USING MINIMALLY INVASIVE TISSUE SAMPLING (MITS): RESULTS FROM CHILD HEALTH AND MORTALITY PREVENTION SURVEILLANCE (CHAMPS). (ID 166)
Determining pneumonia etiology is difficult because samples from inside the lung are rarely available. We describe fatal pneumonia etiology, determined using MITS, to investigate cause of death (CoD) in children aged 1-59 months from seven countries in Africa and South Asia.
Deaths that occurred between December 2016 and February 2020 were investigated post-mortem using blood samples (tested by culture and PCR) and MITS per lung (histopathology, PCR for 44 organisms [all sites] and culture [South Africa only]). Expert panels reviewed clinical data, MITS and culture results, and verbal autopsy and assigned underlying, antecedent/comorbid and immediate (final event) CoD per WHO recommendations.
Pneumonia was the underlying (n=54), antecedent (n=108) and/or immediate (n=128) CoD in 273/594 (46%) deaths; South Africa, Kenya, Mozambique, Sierra Leone, Mali, Ethiopia and Bangladesh contributed 113, 50, 47, 28, 24, 10 and 1 pneumonia-related deaths, respectively. Median age was 8.4 (IQR: 3.3-19.4) months. Pneumonia deaths had a median of 2 (IQR: 1-3) implicated pathogens. The 10 leading pathogens (including co-infections) were Streptococcus pneumoniae (31.9%), Klebsiella pneumoniae (31.5%), Cytomegalovirus (14.3%), Haemophilus influenzae (10.7%), Staphylococcus aureus (9.9%), Respiratory syncytial virus (7.0%), Pneumocystis jirovecii (8.1%), Acinetobacter baumanii (5.1%), and adenovirus (5.1%).
CHAMPS methods provide a new way of examining pathogen-specific causes of pneumonia death, highlighting those deaths often had multiple pathogens and Klebsiella pneumoniae may cause more pneumonia deaths than previously thought. Despite use of pneumococcal conjugate vaccines at all sites, pneumococcus still caused 32% of childhood pneumonia-related deaths.