ObjectivePneumonia remains the leading cause of hospitalisations and deaths among children aged <5 years. Diverse respiratory pathogens cause acute respiratory infections, including pneumonia. Here, we analysed viral and bacterial pathogens and risk factors associated with death of hospitalised children.DesignA 9-year case series study.SettingTwo secondary-care hospitals, one tertiary-care hospital and one research centre in the Philippines.Participants5054 children aged <5 years hospitalised with severe pneumonia.MethodsNasopharyngeal swabs for virus identification, and venous blood samples for bacterial culture were collected. Demographic, clinical data and laboratory findings were collected at admission time. Logistic regression analyses were performed to identify the factors associated with death.ResultsOf the enrolled patients, 57% (2876/5054) were males. The case fatality rate was 4.7% (238/5054), showing a decreasing trend during the study period (p<0.001). 55.0% of the patients who died were either moderately or severely underweight. Viruses were detected in 61.0% of the patients, with respiratory syncytial virus (27.0%) and rhinovirus (23.0%) being the most commonly detected viruses. In children aged 2–59 months, the risk factors significantly associated with death included age of 2–5 months, sensorial changes, severe malnutrition, grunting, central cyanosis, decreased breath sounds, tachypnoea, fever (≥38.5°C), saturation of peripheral oxygen <90%, infiltration, consolidation and pleural effusion on chest radiograph.Among the pathogens, adenovirus type 7, seasonal influenza A (H1N1) and positive blood culture for bacteria were significantly associated with death. Similar patterns were observed between the death cases and the aforementioned factors in children aged <2 months.ConclusionMalnutrition was the most common factor associated with death and addressing this issue may decrease the case fatality rate. In addition, chest radiographic examination and oxygen saturation measurement should be promoted in all hospitalised patients with pneumonia as well as bacteria detection to identify patients who are at risk of death.

We report a new norovirus GII.4 variant, GII.4 Hong Kong, with low-level circulation in 4 Eurasia countries since mid-2017. Amino acid substitutions in key residues on the virus capsid associated with the emergence of pandemic noroviruses suggest that GII.4 Hong Kong has the potential to become the next pandemic variant.

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Purpose: Pneumocystis jivoreci is an opportunistic pathogen which can lead to life threatening respiratory failure. It has a documented mortality of between 5-20%. Historically it was almost exclusive to HIV patients however; an increase in immunosuppressive therapies has led to a reciprocal increase in the prevalence of Pneumocystis pneumonia (PJP) in this non-HIV population.Despite clear guidelines for PJP prophylaxis in HIV, there is a haphazard approach in other immunosuppressed populations.A growing body of evidence suggests that immunosuppressed patients are at an increased risk of PJP, but to what extent, or to whom that risk is greatest is not certain.Given this uncertainty we felt it prudent to review regional rates of PJP to develop a clearer understanding of the potential at risk population.Methods & Materials: We audited a random cohort of 103 patients with Pneumocystis pneumonia over a 5 year period in a region in the United Kingdom. We collated information on potential risk factors, morbidity and mortality.Results: The highest proportion of patients were cancer patients, however the most at risk population were rheumatology patients, with a 73% mortality rate in those who tested positive for PCP.Admission to ICU was 38% and mortality was 32%. Mortality was highest when prescribed three modalities of immunosuppression in combination; however prednisolone alone carries a mortality rate of 62%. Conclusion:We feel that prophylaxis guidelines should be considered in these identified high risk groups, but much more study is required on the absolute risk, and on how prophylaxis should be approached.

Dengue has been one of the major public health concerns in the Philippines for more than a century. The annual dengue case burden has been increasing in recent years, exceeding 200,000 in 2015 and 2019. However, there is limited information on the molecular epidemiology of dengue in the Philippines. We, therefore, conducted a study to understand the genetic composition and dispersal of DENV in the Philippines from 2015 to 2017 under UNITEDengue. Our analyses included 377 envelope (E) gene sequences of all 4 serotypes obtained from infections in 3 main island groups (Luzon, Visayas, and Mindanao) of the Philippines. The findings showed that the overall diversity of DENV was generally low. DENV-1 was relatively more diverse than the other serotypes. Virus dispersal was evident among the three main island groups, but each island group demonstrated a distinct genotype composition. These observations suggested that the intensity of virus dispersal was not substantive enough to maintain a uniform heterogeneity among island groups so that each island group behaved as an independent epidemiological unit. The analyses suggested Luzon as one of the major sources of DENV emergence and CAR, Calabarzon, and CARAGA as important hubs of virus dispersal in the Philippines. Our findings highlight the importance of virus surveillance and molecular epidemiological analyses to gain deep insights into virus diversity, lineage dominance, and dispersal patterns that could assist in understanding the epidemiology and transmission risk of dengue in endemic regions.