Postmortem study of cause of death among children hospitalized with respiratory illness in Kenya

Henry N Njuguna; Sherif R Zaki; Drucilla J Roberts; Emily A Rogena; Edwin Walong; Corinne L Fligner; M Kelly Keating; Andrew K Gachii; Elizabeth Maleche-Obimbo; Grace Irimu; John Mathaiya; Noelle Orata; Rosemarie Lopokoiyit; Jackson Michuki; Gideon O Emukule; Clayton O Onyango; Stella Gikunju; Collins Owuor; Peter K Muturi; Milka Bunei; Maria Gloria Carvalho; Barry Fields; Joshua A Mott; Marc-Alain Widdowson; Sandra S Chaves

doi:10.1097/INF.0000000000003159

Postmortem study of cause of death among children hospitalized with respiratory illness in Kenya

Henry N Njuguna, Sherif R Zaki, Drucilla J Roberts, Emily A Rogena, Edwin Walong, Corinne L Fligner, M Kelly Keating, Andrew K Gachii, Elizabeth Maleche-Obimbo, Grace Irimu, John Mathaiya, Noelle Orata, Rosemarie Lopokoiyit, Jackson Michuki, Gideon O Emukule, Clayton O Onyango, Stella Gikunju, Collins Owuor, Peter K Muturi, Milka BuneiMaria Gloria Carvalho, Barry Fields, Joshua A Mott, Marc-Alain Widdowson, Sandra S Chaves

Institute of Tropical Medicine

Research output: Contribution to journal › A1: Web of Science-article › peer-review

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Abstract

BACKGROUND: In resource-limited settings, acute respiratory infections continue to be the leading cause of death in young children. We conducted postmortem investigations in children <5 years hospitalized with a clinical diagnosis of respiratory disease at Kenya's largest referral hospital.

METHODS: We collected respiratory and other tissues postmortem to examine pathologic processes using histology, molecular and immunohistochemistry assays. Nasopharyngeal, trachea, bronchi and lung specimens were tested using 21-target respiratory pathogen real-time reverse transcription polymerase chain reaction assays deployed on Taqman Array Cards. Expert panels reviewed all findings to determine causes of death and associated pathogens.

RESULTS: From 2014 to 2015, we investigated 64 pediatric deaths (median age 7 months). Pneumonia was determined as cause of death in 70% (42/52) of cases where death was associated with an infectious disease process. The main etiologies of pneumonia deaths were respiratory syncytial virus (RSV) (n = 7, 19%), Pneumocystis jirovecii (n = 7, 19%), influenza A (n = 5, 14%) and Streptococcus pneumoniae (n = 5, 14%)-10% of cases had multi-pathogen involvement. Among the other 10 deaths associated with a nonpneumonia infectious process, 4 did not have an etiology assigned, the others were associated with miliary tuberculosis (2), cerebral thrombosis due to HIV (1), Enterobacteriaceae (1), rotavirus (1), and 1 case of respiratory infection with severe hypokalemia associated with RSV.

CONCLUSIONS: In spite of well-established vaccination programs in Kenya, some deaths were still vaccine preventable. Accelerated development of RSV monoclonal antibodies and vaccines, introduction of seasonal influenza vaccination, and maintenance or improved uptake of existing vaccines can contribute to further reductions in childhood mortality.

Original language	English
Journal	Pediatric Infectious Diseases Journal
Volume	40
Issue number	8
Pages (from-to)	715-722
Number of pages	8
ISSN	0891-3668
DOIs	https://doi.org/10.1097/INF.0000000000003159
Publication status	Published - 2021

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2021pidj0715Final published version, 652 KBLicence: CC BY-NC-ND

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Njuguna, H. N., Zaki, S. R., Roberts, D. J., Rogena, E. A., Walong, E., Fligner, C. L., Keating, M. K., Gachii, A. K., Maleche-Obimbo, E., Irimu, G., Mathaiya, J., Orata, N., Lopokoiyit, R., Michuki, J., Emukule, G. O., Onyango, C. O., Gikunju, S., Owuor, C., Muturi, P. K., ... Chaves, S. S. (2021). Postmortem study of cause of death among children hospitalized with respiratory illness in Kenya. Pediatric Infectious Diseases Journal, 40(8), 715-722. https://doi.org/10.1097/INF.0000000000003159

@article{733e51c6b8be4cc583525392dc447e7f,

title = "Postmortem study of cause of death among children hospitalized with respiratory illness in Kenya",

abstract = "BACKGROUND: In resource-limited settings, acute respiratory infections continue to be the leading cause of death in young children. We conducted postmortem investigations in children <5 years hospitalized with a clinical diagnosis of respiratory disease at Kenya's largest referral hospital.METHODS: We collected respiratory and other tissues postmortem to examine pathologic processes using histology, molecular and immunohistochemistry assays. Nasopharyngeal, trachea, bronchi and lung specimens were tested using 21-target respiratory pathogen real-time reverse transcription polymerase chain reaction assays deployed on Taqman Array Cards. Expert panels reviewed all findings to determine causes of death and associated pathogens.RESULTS: From 2014 to 2015, we investigated 64 pediatric deaths (median age 7 months). Pneumonia was determined as cause of death in 70% (42/52) of cases where death was associated with an infectious disease process. The main etiologies of pneumonia deaths were respiratory syncytial virus (RSV) (n = 7, 19%), Pneumocystis jirovecii (n = 7, 19%), influenza A (n = 5, 14%) and Streptococcus pneumoniae (n = 5, 14%)-10% of cases had multi-pathogen involvement. Among the other 10 deaths associated with a nonpneumonia infectious process, 4 did not have an etiology assigned, the others were associated with miliary tuberculosis (2), cerebral thrombosis due to HIV (1), Enterobacteriaceae (1), rotavirus (1), and 1 case of respiratory infection with severe hypokalemia associated with RSV.CONCLUSIONS: In spite of well-established vaccination programs in Kenya, some deaths were still vaccine preventable. Accelerated development of RSV monoclonal antibodies and vaccines, introduction of seasonal influenza vaccination, and maintenance or improved uptake of existing vaccines can contribute to further reductions in childhood mortality.",

author = "Njuguna, {Henry N} and Zaki, {Sherif R} and Roberts, {Drucilla J} and Rogena, {Emily A} and Edwin Walong and Fligner, {Corinne L} and Keating, {M Kelly} and Gachii, {Andrew K} and Elizabeth Maleche-Obimbo and Grace Irimu and John Mathaiya and Noelle Orata and Rosemarie Lopokoiyit and Jackson Michuki and Emukule, {Gideon O} and Onyango, {Clayton O} and Stella Gikunju and Collins Owuor and Muturi, {Peter K} and Milka Bunei and {Gloria Carvalho}, Maria and Barry Fields and Mott, {Joshua A} and Marc-Alain Widdowson and Chaves, {Sandra S}",

year = "2021",

doi = "10.1097/INF.0000000000003159",

language = "English",

volume = "40",

pages = "715--722",

journal = "Pediatric Infectious Diseases Journal",

issn = "0891-3668",

publisher = "Lippincott Williams and Wilkins",

number = "8",

}

Njuguna, HN, Zaki, SR, Roberts, DJ, Rogena, EA, Walong, E, Fligner, CL, Keating, MK, Gachii, AK, Maleche-Obimbo, E, Irimu, G, Mathaiya, J, Orata, N, Lopokoiyit, R, Michuki, J, Emukule, GO, Onyango, CO, Gikunju, S, Owuor, C, Muturi, PK, Bunei, M, Gloria Carvalho, M, Fields, B, Mott, JA, Widdowson, M-A & Chaves, SS 2021, 'Postmortem study of cause of death among children hospitalized with respiratory illness in Kenya', Pediatric Infectious Diseases Journal, vol. 40, no. 8, pp. 715-722. https://doi.org/10.1097/INF.0000000000003159

TY - JOUR

T1 - Postmortem study of cause of death among children hospitalized with respiratory illness in Kenya

AU - Njuguna, Henry N

AU - Zaki, Sherif R

AU - Roberts, Drucilla J

AU - Rogena, Emily A

AU - Walong, Edwin

AU - Fligner, Corinne L

AU - Keating, M Kelly

AU - Gachii, Andrew K

AU - Maleche-Obimbo, Elizabeth

AU - Irimu, Grace

AU - Mathaiya, John

AU - Orata, Noelle

AU - Lopokoiyit, Rosemarie

AU - Michuki, Jackson

AU - Emukule, Gideon O

AU - Onyango, Clayton O

AU - Gikunju, Stella

AU - Owuor, Collins

AU - Muturi, Peter K

AU - Bunei, Milka

AU - Gloria Carvalho, Maria

AU - Fields, Barry

AU - Mott, Joshua A

AU - Widdowson, Marc-Alain

AU - Chaves, Sandra S

PY - 2021

Y1 - 2021

N2 - BACKGROUND: In resource-limited settings, acute respiratory infections continue to be the leading cause of death in young children. We conducted postmortem investigations in children <5 years hospitalized with a clinical diagnosis of respiratory disease at Kenya's largest referral hospital.METHODS: We collected respiratory and other tissues postmortem to examine pathologic processes using histology, molecular and immunohistochemistry assays. Nasopharyngeal, trachea, bronchi and lung specimens were tested using 21-target respiratory pathogen real-time reverse transcription polymerase chain reaction assays deployed on Taqman Array Cards. Expert panels reviewed all findings to determine causes of death and associated pathogens.RESULTS: From 2014 to 2015, we investigated 64 pediatric deaths (median age 7 months). Pneumonia was determined as cause of death in 70% (42/52) of cases where death was associated with an infectious disease process. The main etiologies of pneumonia deaths were respiratory syncytial virus (RSV) (n = 7, 19%), Pneumocystis jirovecii (n = 7, 19%), influenza A (n = 5, 14%) and Streptococcus pneumoniae (n = 5, 14%)-10% of cases had multi-pathogen involvement. Among the other 10 deaths associated with a nonpneumonia infectious process, 4 did not have an etiology assigned, the others were associated with miliary tuberculosis (2), cerebral thrombosis due to HIV (1), Enterobacteriaceae (1), rotavirus (1), and 1 case of respiratory infection with severe hypokalemia associated with RSV.CONCLUSIONS: In spite of well-established vaccination programs in Kenya, some deaths were still vaccine preventable. Accelerated development of RSV monoclonal antibodies and vaccines, introduction of seasonal influenza vaccination, and maintenance or improved uptake of existing vaccines can contribute to further reductions in childhood mortality.

AB - BACKGROUND: In resource-limited settings, acute respiratory infections continue to be the leading cause of death in young children. We conducted postmortem investigations in children <5 years hospitalized with a clinical diagnosis of respiratory disease at Kenya's largest referral hospital.METHODS: We collected respiratory and other tissues postmortem to examine pathologic processes using histology, molecular and immunohistochemistry assays. Nasopharyngeal, trachea, bronchi and lung specimens were tested using 21-target respiratory pathogen real-time reverse transcription polymerase chain reaction assays deployed on Taqman Array Cards. Expert panels reviewed all findings to determine causes of death and associated pathogens.RESULTS: From 2014 to 2015, we investigated 64 pediatric deaths (median age 7 months). Pneumonia was determined as cause of death in 70% (42/52) of cases where death was associated with an infectious disease process. The main etiologies of pneumonia deaths were respiratory syncytial virus (RSV) (n = 7, 19%), Pneumocystis jirovecii (n = 7, 19%), influenza A (n = 5, 14%) and Streptococcus pneumoniae (n = 5, 14%)-10% of cases had multi-pathogen involvement. Among the other 10 deaths associated with a nonpneumonia infectious process, 4 did not have an etiology assigned, the others were associated with miliary tuberculosis (2), cerebral thrombosis due to HIV (1), Enterobacteriaceae (1), rotavirus (1), and 1 case of respiratory infection with severe hypokalemia associated with RSV.CONCLUSIONS: In spite of well-established vaccination programs in Kenya, some deaths were still vaccine preventable. Accelerated development of RSV monoclonal antibodies and vaccines, introduction of seasonal influenza vaccination, and maintenance or improved uptake of existing vaccines can contribute to further reductions in childhood mortality.

U2 - 10.1097/INF.0000000000003159

DO - 10.1097/INF.0000000000003159

M3 - A1: Web of Science-article

C2 - 33967229

SN - 0891-3668

VL - 40

SP - 715

EP - 722

JO - Pediatric Infectious Diseases Journal

JF - Pediatric Infectious Diseases Journal

IS - 8

ER -

Postmortem study of cause of death among children hospitalized with respiratory illness in Kenya

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