Epidemiology of community-acquired pneumonia among hospitalised children in Indonesia: a multicentre, prospective study

Abstract

ObjectiveTo identify aetiologies of childhood community-acquired pneumonia (CAP) based on a comprehensive diagnostic approach.Design‘Partnerships for Enhanced Engagement in Research-Pneumonia in Paediatrics (PEER-PePPeS)’ study was an observational prospective cohort study conducted from July 2017 to September 2019.SettingGovernment referral teaching hospitals and satellite sites in three cities in Indonesia: Semarang, Yogyakarta and Tangerang.ParticipantsHospitalised children aged 2–59 months who met the criteria for pneumonia were eligible. Children were excluded if they had been hospitalised for >24 hours; had malignancy or history of malignancy; a history of long-term (>2 months) steroid therapy, or conditions that might interfere with compliance with study procedures.Main outcome(s) measure(s)Causative bacterial, viral or mixed pathogen(s) for pneumonia were determined using microbiological, molecular and serological tests from routinely collected specimens (blood, sputum and nasopharyngeal swabs). We applied a previously published algorithm (PEER-PePPeS rules) to determine the causative pathogen(s).Results188 subjects were enrolled. Based on our algorithm, 48 (25.5%) had a bacterial infection, 31 (16.5%) had a viral infection, 76 (40.4%) had mixed bacterial and viral infections, and 33 (17.6%) were unable to be classified. The five most common causative pathogens identified were Haemophilus influenzae non-type B (N=73, 38.8%), respiratory syncytial virus (RSV) (N=51, 27.1%), Klebsiella pneumoniae (N=43, 22.9%), Streptococcus pneumoniae (N=29, 15.4%) and Influenza virus (N=25, 13.3%). RSV and influenza virus diagnoses were highly associated with Indonesia’s rainy season (November–March). The PCR assays on induced sputum (IS) specimens captured most of the pathogens identified in this study.ConclusionsOur study found that H. influenzae non-type B and RSV were the most frequently identified pathogens causing hospitalised CAP among Indonesian children aged 2–59 months old. Our study also highlights the importance of PCR for diagnosis and by extension, appropriate use of antimicrobials.Trail registration numberNCT03366454

Age-Dependent Clinical Characteristics of Acute Lower Respiratory Infections in Young Hospitalized Children with Respiratory Syncytial Virus Infection

“…It causes significant morbidity and necessitates hospitalization in young children. 1 The infection occurs in all age groups, but most children are infected at or before 2 years of age. 2 Patients with HRSV bronchiolitis usually present with two to four days of upper respiratory tract symptoms such as fever, rhinorrhea, and congestion, followed by lower respiratory tract symptoms such as increasing cough, wheezing, and increased respiratory effort.…”

Comparison of Immunogenicity and Safety of Diphtheria–Tetanus–Pertussis–Hepatitis B–Haemophilus influenza B (Bio Farma) with Pentabio® Vaccine Primed with Recombinant Hepatitis B at Birth (Using Different Source of Hepatitis B) in Indonesian Infants

“…In 2022, a study in Indonesia found that Hib is one of the pathogens responsible for causing pneumonia that requires hospitalization among Indonesian children aged 2–59 months old. Hib conjugate vaccine programs have alleviated the global burden of Hib meningitis in children [ 46 ].…”

Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia

“…Yet discriminating bacterial and viral etiologies of pneumonia in children remains challenging ( 2 ). Despite evidence that appropriate antibiotics are lifesaving, in low-resource settings, rational selection of antibiotics for pneumonia is hampered by limited access to gold standard diagnostic tests, which are often costly and require specialized equipment and techniques ( 3 , 4 ). Consequently, healthcare providers, particularly those in low-income and middle-income countries (LMIC), likely overtreat non-bacterial pneumonia with antibiotics, which may accelerate development of antimicrobial resistance (AMR) ( 2 , 3 , 5 ).…”

“…The Partnerships for Enhanced Engagement in Research-Pneumonia in Pediatrics (PEER-PePPeS) study was a multisite observational cohort study in Indonesia designed to identify etiologies of childhood CAP using comprehensive diagnostic methods ( 4 ). Causative bacterial, viral or mixed viral-bacterial pneumonia pathogens were determined using a previously published algorithm based on microbiological, molecular and serological testing as the gold standard ( 2 ).…”