The epidemiology of febrile illness in sub-Saharan Africa: implications for diagnosis and management.

BACKGROUND: Fever is among the most common symptoms of people living in Africa, and clinicians are challenged by the similar clinical features of a wide spectrum of potential aetiologies. AIM: To summarize recent studies of fever aetiology in sub-Saharan Africa focusing on causes other than malaria. SOURCES: A narrative literature review by searching the MEDLINE database, and recent conference abstracts. CONTENT: Studies of multiple potential causes of fever are scarce, and for many participants the infecting organism remains unidentified, or multiple co-infecting microorganisms are identified, and establishing causation is challenging. Among ambulatory patients, self-limiting arboviral infections and viral upper respiratory infections are common, occurring in up to 60% of children attending health centres. Among hospitalized patients there is a high prevalence of potentially fatal infections requiring specific treatment. Bacterial bloodstream infection and bacterial zoonoses are major causes of fever. In recent years, the prevalence of antimicrobial resistance among bacterial isolates has increased, notably with spread of extended spectrum ß-lactamase-producing Enterobacteriaceae and fluoroquinolone-resistant Salmonella enterica. Among those with human immunodeficiency virus (HIV) infection, Mycobacterium tuberculosis bacteraemia has been confirmed in up to 34.8% of patients with sepsis, and fungal infections such as cryptococcosis and histoplasmosis remain important. IMPLICATIONS: Understanding the local epidemiology of fever aetiology, and the use of diagnostics including malaria and HIV rapid-diagnostic tests, guides healthcare workers in the management of patients with fever. Current challenges for clinicians include assessing which ambulatory patients require antibacterial drugs, and identifying hospitalized patients infected with organisms that are not susceptible to empiric antibacterial regimens.

La pediatría en las Jornadas Internacionales de Cine Médico de San Sebastián / Pediatrics at the International Medical Film Festival of San Sebastián

Introducción: Las Jornadas Internacionales de Cine Médico de San Sebastián fueron una actividad científica y divulgativa del cine médico (22 ediciones) cuando el acceso a estas proyecciones era muy dificultoso (1969-1991). El objetivo del presente trabajo es analizar la presencia de los temas pediátricos y su repercusión en dichas jornadas. Método: Revisión de la prensa local entre los años 1968 y 1980, los programas de mano entre los años 1981 y 1991, los boletines informativos y las memorias de las Jornadas. Resultados: De las 899 películas entre cine y vídeo presentadas en las Jornadas, 103 fueron de tema pediátrico, lo que supone un 11,4% de las mismas. Se analizan los premios, los ciclos especiales de películas y los ciclos de conferencias relativas a la atención a la infancia y la adolescencia. Conclusiones: A pesar de que la orientación de las Jornadas era eminentemente quirúrgica, la presencia de la pediatría, sobre todo en su vertiente de educación sanitaria, fue importante. La educación sexual, la psicología y la discapacidad infantil fueron los temas más presentes (AU)

Introduction: San Sebastian International Medical Film Journeys were a scientific and educational activity of medical film (22 editions) when the access to these projections was very difficult. The objective of the present study is to analyze the presence of Pediatric subjects and their impact on these journeys. Method: Review of the local press (years 1968-1980), the programs hand (years 1981-1991), newsletters and the memories of the journeys. Results: 899 movies, film or video, were presented in the Journeys. One hundred and three of them were about Pediatric subject, representing 11.4%. We are going to analyze them awards, special cycles of movies and conferences. Conclusions: The orientation of these journeys was eminently surgical, but the presence of the Pediatrics was important, above all in his shed of education health. The themes sex education, psychology, and child disability were the most present (AU)

Multicentre study highlighting clinical relevance of new high-throughput methodologies in molecular epidemiology of Pneumocystis jirovecii pneumonia.

Pneumocystis jirovecii causes severe interstitial pneumonia (PcP) in immunosuppressed patients. This multicentre study assessed the distribution frequencies of epidemiologically relevant genetic markers of P. jirovecii in different geographic populations from Portugal, the USA, Spain, Cuba and Mozambique, and the relationship between the molecular data and the geographical and clinical information, based on a multifactorial approach. The high-throughput typing strategy for P. jirovecii characterization consisted of DNA pooling using quantitative real-time PCR followed by multiplex-PCR/single base extension. The frequencies of relevant P. jirovecii single nucleotide polymorphisms (mt85, SOD110, SOD215, DHFR312, DHPS165 and DHPS171) encoded at four loci were estimated in ten DNA pooled samples representing a total of 182 individual samples. Putative multilocus genotypes of P. jirovecii were shown to be clustered due to geographic differences but were also dependent on clinical characteristics of the populations studied. The haplotype DHFR312T/SOD110C/SOD215T was associated with severe AIDS-related PcP and high P. jirovecii burdens. The frequencies of this genetic variant of P. jirovecii were significantly higher in patients with AIDS-related PcP from Portugal and the USA than in the colonized patients from Portugal, and Spain, and children infected with P. jirovecii from Cuba or Mozambique, highlighting the importance of this haplotype, apparently associated with the severity of the disease and specific clinical groups. Patients from the USA and Mozambique showed higher rates of DHPS mutants, which may suggest the circulation of P. jirovecii organisms potentially related with trimethoprim-sulfamethoxazole resistance in those geographical regions. This report assessed the worldwide distribution of P. jirovecii haplotypes and their epidemiological impact in distinct geographic and clinical populations.

A comparison of human metapneumovirus and respiratory syncytial virus WHO-defined severe pneumonia in Moroccan children.

Acute respiratory infections remain the principal cause of morbidity and mortality in Moroccan children. Besides bacterial infections, respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are prominent among other viruses due to their high prevalence and association with severe clinical episodes. We aimed to describe and compare RSV- and hMPV-associated cases of WHO-defined severe pneumonia in a paediatric population admitted to Morocco's reference hospital. Children aged 2-59 months admitted to the Hôpital d'Enfants de Rabat, Morocco meeting WHO-defined severe pneumonia criteria were recruited during 14 months and thoroughly investigated to ascertain a definitive diagnosis. Viral prevalence of RSV, hMPV and other viruses causing respiratory symptoms was investigated in nasopharyngeal aspirate samples through the use of molecular methods. Of the 683 children recruited and included in the final analysis, 61/683 (8·9%) and 124/683 (18·2%) were infected with hMPV and RSV, respectively. Besides a borderline significant tendency for higher age in hMPV cases, patients infected with either of the viruses behaved similarly in terms of demographics, patient history, past morbidity and comorbidity, vaccination history, socioeconomic background and family environment. Clinical presentation on arrival was also similar for both viruses, but hMPV cases were associated with more severity than RSV cases, had a higher risk of intensive care need, and received antibiotic treatment more frequently. RSV and hMPV are common and potentially life-threatening causes of WHO-defined pneumonia in Moroccan children. Both viruses show indistinctive clinical symptomatology, but in Moroccan children, hMPV was associated with a more severe evolution.

High prevalence of Pneumocystis jirovecii pneumonia among Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia.

We aimed to describe Pneumocystis jirovecii pneumonia (PCP) prevalence and features in children from sub-Saharan Africa and to investigate PCP-associated risk factors. During 2006-2007 we used molecular methods to test children younger than 5 years old admitted with severe pneumonia to a hospital in southern Mozambique for Pneumocystis infection. We recruited 834 children. PCP prevalence was 6.8% and HIV prevalence was 25.7%. The in-hospital and delayed mortality were significantly higher among children with PCP (20.8% vs. 10.2%, p 0.021, and 11.5% vs. 3.6%, p 0.044, respectively). Clinical features were mostly overlapping between the two groups. Independent risk factors for PCP were age less than a year (odds ratio (OR) 6.34, 95% confidence interval (CI) 1.86-21.65), HIV infection (OR 2.99, 95% CI 1.16-7.70), grunting (OR 2.64, 95% CI 1.04-6.73) and digital clubbing (OR 10.75, 95% CI 1.21-95.56). PCP is a common and life-threatening cause of severe pneumonia in Mozambican children. Mother-to-child HIV transmission prevention should be strengthened. Better diagnostic tools are needed.

Salud infantil y cooperación internacional: una aproximación pediátrica / Child health and international cooperation: A paediatric approach

La cooperación internacional al desarrollo en salud infantil despierta un especial interés en el ámbito pediátrico. En los últimos decenios se han ido revelando nuevas evidencias en torno al análisis de los factores vinculados a la morbimortalidad en las primeras etapas de la vida en los países menos adelantados. Este mayor conocimiento del origen de los problemas de salud y las posibles respuestas en forma de intervenciones con impacto determina la necesidad de su divulgación entre los profesionales de Pediatría interesados. Se hacen necesarios mayores esfuerzos para profundizar en materias relacionadas con salud global infantil y favorecer el que los pediatras conozcan y participen en estos procesos. Este artículo pretende ofrecer un acercamiento pediátrico social hacia los elementos relacionados con cooperación internacional y salud infantil

The international development cooperation in child health arouses special interest in paediatric settings. In the last 10 10 years or so, new evidence has been presented on factors associated with morbidity and mortality in the first years of life in the least developed countries. This greater knowledge on the causes of health problems and possible responses in the form of interventions with impact, leads to the need to disseminate this information among concerned professional pediatricians. Serious efforts are needed to get a deeper insight into matters related to global child health and encourage pediatricians to be aware and participate in these processes. This article aims to provide a social pediatric approach towards international cooperation and child health-related matters

[Child health and international cooperation: A paediatric approach]. / Salud infantil y cooperación internacional: una aproximación pediátrica.

The international development cooperation in child health arouses special interest in paediatric settings. In the last 10 10 years or so, new evidence has been presented on factors associated with morbidity and mortality in the first years of life in the least developed countries. This greater knowledge on the causes of health problems and possible responses in the form of interventions with impact, leads to the need to disseminate this information among concerned professional pediatricians. Serious efforts are needed to get a deeper insight into matters related to global child health and encourage pediatricians to be aware and participate in these processes. This article aims to provide a social pediatric approach towards international cooperation and child health-related matters.

Tal como éramos. En el centenario del Primer Congreso Español de Pediatría de Palma de Mallorca (1914-2014) / The way we were. On the centenary of the first Spanish Congress of Paediatrics in Palma de Mallorca (1914-2014)

Entre los días 19 y 25 de abril de 1914 se celebró en Palma de Mallorca el Primer Congreso Español de Pediatría, bajo el lema «Proteged a los niños». La especialidad se había desgajado hacía pocos años de su secular vinculación con la Obstetricia y la Ginecología, tanto en su aspecto docente como asistencial. Con las cátedras de Enfermedades de la Infancia recién creadas, en cierto modo, este Congreso significaba la puesta de largo de la Pediatría en nuestro país. El Prof. Martínez Vargas, catedrático en Barcelona, fue el presidente y el alma del Congreso. Era preciso hacer frente a una elevadísima tasa de mortalidad infantil. El Congreso respondió a aquella demanda social y sanitaria en la que participaron más de 300 pediatras, con representantes extranjeros de Bélgica, Francia, Rusia e Hispanoamérica. Las actividades se distribuyeron en 4 secciones: Puericultura, Medicina Infantil, Cirugía e Higiene, y acreditados profesores impartieron conferencias magistrales sobre los temas de la patología infantil más acuciantes de la época. Cien años después, lo que hoy somos es el fruto recogido de quienes nos precedieron; unos fueron figuras brillantes de la pediatría y otros, la mayoría, pediatras anónimos. Consagraron sus vidas, su ciencia y la mejor de sus sonrisas al cuidado del niño. Así éramos, y así somos. Con satisfacción y legítimo orgullo, es un honor, para el Grupo de Historia de la Pediatría y Documentación de la AEP, celebrar esta conmemoración centenaria en el marco de Anales de Pediatría

Between the 19th and 25th April 1914, the First Spanish Congress of Paediatrics was held in Palma de Mallorca under the slogan ''Protect the Children''. The specialty had broken away a few years earlier from its secular connection with Obstetrics and Gynaecology, both in its teaching aspect as well as regarding healthcare. With the newly created Chairs in Childhood Diseases, in a way this Congress meant the coming-of age and debut int society of paediatrics in our country. Prof. Martínez Vargas, a university professor in Barcelona, was the Chairman, and soul of the congress. There was a need to face a very high rate of infant mortality. The Congress responded to that social and sanitary/health demand with the participation of over three hundred pediatricians, including foreign representatives from Belgium, France, Russia and Latin America. The activities were divided into four sections: Childcare, Child Medicine, Surgery and Health, and accredited lecturers gave master classes on the most pressing issuesof child pathology of the time. One hundred years on, what we are today is the fruit gatheredby those who preceded us. Some were brilliant figures in paediatrics and others, the majority, anonymous paediatricians. They dedicated their lives, their science and their best smile to child care. The way we were and the way we are. With legitimate pride and satisfaction, it is an honour for the Group on the History of Paediatrics and AEP Documentation to celebrate this centennial commemoration in the framework of the Annals of Paediatrics

[The way we were. On the centenary of the first Spanish Congress of Paediatrics in Palma de Mallorca (1914-2014)]. / Tal como éramos. En el centenario del Primer Congreso Español de Pediatría de Palma de Mallorca (1914-2014).

Between the 19th and 25th April 1914, the First Spanish Congress of Paediatrics was held in Palma de Mallorca under the slogan "Protect the Children". The specialty had broken away a few years earlier from its secular connection with Obstetrics and Gynaecology, both in its teaching aspect as well as regarding healthcare. With the newly created Chairs in Childhood Diseases, in a way this Congress meant the coming-of age and debut int society of paediatrics in our country. Prof. Martínez Vargas, a university professor in Barcelona, was the Chairman, and soul of the congress. There was a need to face a very high rate of infant mortality. The Congress responded to that social and sanitary/health demand with the participation of over three hundred pediatricians, including foreign representatives from Belgium, France, Russia and Latin America. The activities were divided into four sections: Childcare, Child Medicine, Surgery and Health, and accredited lecturers gave master classes on the most pressing issues of child pathology of the time. One hundred years on, what we are today is the fruit gathered by those who preceded us. Some were brilliant figures in paediatrics and others, the majority, anonymous paediatricians. They dedicated their lives, their science and their best smile to child care. The way we were and the way we are. With legitimate pride and satisfaction, it is an honour for the Group on the History of Paediatrics and AEP Documentation to celebrate this centennial commemoration in the framework of the Annals of Paediatrics.

Bibliografía española de algunos síndromes malformativos. Las primeras descripciones / Malformation syndromes in the spanish literature: The first descriptions

Introducción: Los síndromes malformativos o dismórficos son entidades que se definen por la asociación característica de un conjunto de malformaciones mayores y menores que, generalmente, tienen un origen genético. Hemos investigado las primeras descripciones españolas de un amplio número de entidades sindrómicas. Material y métodos: Se partió de la definición que aparece en un tratado clásico sobre el tema. Entre los 60 síndromes escogidos, se estudiaron, al menos, 2 artículos de cada entidad entre los publicados en España y el primero en el tiempo que figura en el Índice Médico Español. Para los años previos a 1970, se amplió la búsqueda en PubMed. Resultados: Se han reunido 64 artículos que corresponden a 58 síndromes. Cuatro artículos se escribieron durante la primera mitad del siglo XX . En la década de los setenta aparecieron casi la mitad de los trabajos (n = 30). Los trabajos se publicaron en 10 revistas pediátricas españolas, en 9 españolas no pediátricas, en 3 pediátricas no españolas y en 2 no pediátricas y no españolas. Las revistas con más artículos publicados fueron Anales de Pediatría y Revista Española de Pediatría. Los hospitales que firmaron artículos con más frecuencia fueron La Paz de Madrid y el Clínico de Barcelona. El resto de los trabajos se escribieron en 30 hospitales pediátricos españoles más y en 2 extranjeros. El número de autores se fue incrementando con el paso del tiempo. Conclusiones: Aunque con posibles limitaciones, hemos localizado las que pueden ser las primeras descripciones de 58 síndromes, entre los 60 escogidos inicialmente (AU)

Introduction: Malformation or dysmorphic syndromes are conditions that are defined by the combination of a set of major and minor malformations that generally have a genetic origin. We investigated the early Spanish descriptions of a large number of sydromes. Material and methods: We started the study from the definition in a classic treatise on the subject. Among the 60 selected syndromes studied, at least two articles of each syndrome among those published in Spain and for the first time were listed in the Spanish Medical Index. For years prior to 1970, it expanded The search was expanded to PubMed, for the years before1970.Results: We collected 64 articles that referred to 58 syndromes. Four articles were written during the first half of the twentieth century. Almost half of the works (n = 30) appeared in the 1970’s. The papers were published in ten Spanish pediatric, nine Spanish non pediatric, three pediatric non-Spanish and two non-Spanish non-pediatric Journals. The Journals with the most articles published were Anales de Pediatría y Revista Española de Pediatría. The hospitals where the articles originate more often were Hospital La Paz, Madrid and Hospital Clinic, Barcelona. The rest of the works were written in 30 pediatric hospitals and two more in non-Spanish hospitals. The number of authors increased with the passage of time. Conclusions: Although there were potential limitations, we have identified what may be the first descriptions of 58 syndromes, among the 60 chosen initially (AU)

[Malformation syndromes in the spanish literature: The first descriptions]. / Bibliografía española de algunos síndromes malformativos. Las primeras descripciones.

INTRODUCTION: Malformation or dysmorphic syndromes are conditions that are defined by the combination of a set of major and minor malformations that generally have a genetic origin. We investigated the early Spanish descriptions of a large number of sydromes. MATERIAL AND METHODS: We started the study from the definition in a classic treatise on the subject. Among the 60 selected syndromes studied, at least two articles of each syndrome among those published in Spain and for the first time were listed in the Spanish Medical Index. For years prior to 1970, it expanded The search was expanded to PubMed, for the years before 1970. RESULTS: We collected 64 articles that referred to 58 syndromes. Four articles were written during the first half of the twentieth century. Almost half of the works (n=30) appeared in the 1970's. The papers were published in ten Spanish pediatric, nine Spanish non-pediatric, three pediatric non-Spanish and two non-Spanish non-pediatric Journals. The Journals with the most articles published were Anales de Pediatría y Revista Española de Pediatría. The hospitals where the articles originate more often were Hospital La Paz, Madrid and Hospital Clinic, Barcelona. The rest of the works were written in 30 pediatric hospitals and two more in non-Spanish hospitals. The number of authors increased with the passage of time. CONCLUSIONS: Although there were potential limitations, we have identified what may be the first descriptions of 58 syndromes, among the 60 chosen initially.

Procalcitonin and C-reactive protein as predictors of blood culture positivity among hospitalised children with severe pneumonia in Mozambique.

OBJECTIVES: To evaluate the benefits of using procalcitonin (PCT) and C-reactive protein (CRP) as pre-screening tools to predict blood culture positivity among Mozambican children with clinical severe pneumonia (CSP). METHODS: 586 children <5 years with CSP and no concurrent malaria fulfilled criteria to be included in the study groups. We determined PCT and CRP for all children with positive bacterial culture (BC+ group, n = 84) and of a random selection of children with negative bacterial culture (BC- group, n = 246). RESULTS: PCT and CRP levels were higher in the BC+ group than the BC- one (PCT: median 7.73 versus 0.48 ng/ml, P < 0.001; CRP: 177.65 mg/l vs. 26.5 mg/l, P < 0.001). In multivariate analysis, PCT was the only independent predictor of the group. To be used as pre-screening tool, PCT presented higher specificities for predetermined sensitivities (≥85%) than CRP. Pursuing a sensitivity of 95%, PCT could reduce the need for bacterial culture by 49% and overall diagnosis costs by 7-35% [assuming variable costs for PCT measurement (ranging from 10 to 30 USD) and a fixed cost of 72.5 USD per blood culture]. CONCLUSIONS: Among hospitalised children with CSP and absence of concurrent malaria, PCT pre-screening could help reduce the number of blood cultures and diagnosis costs by specifically targeting patients more likely to yield positive results.

Serum biomarkers for the diagnosis of malaria, bacterial and viral infections in children living in malaria-endemic areas.

This review assesses current knowledge on the use of serum biomarkers for the diagnosis of malaria, bacterial and viral infections in sick children living in malaria-endemic areas. Reducing pediatric morbidity and mortality remains an essential challenge in these areas, where malaria and bacterial infections are the leading cause of death. In such settings, diagnostic tools that aid to overcome this problem are scarce and diagnosis relies mainly on clinical observations that can lead to incorrect treatment prescriptions. Currently, only malaria RDTs (rapid diagnostic tests) fulfill the criteria for a wide implementation under the operational conditions of resource-limited settings. New, affordable, simple and rapid diagnostic tools for bacterial diagnosis are crucial to guarantee adequate management of antibiotics. Serum biomarkers such as C-reactive protein or procalcitonin, used in developed countries, could form the basis for these tools. Few studies have, however, assessed their validity in malaria-endemic areas and data remain inconclusive. Viral diagnosis is not of highest priority in places where no specific etiological treatment is available and the presence of a virus cannot exclude bacterial/malarial coinfections. Although future studies may elucidate the diagnostic role of certain biomarkers in malaria-endemic areas, understanding the operational and sociological conditions of these settings will remain essential for the successful implementation of current and new diagnostic tools.

La malaria en el mundo en 2010: ¿qué hay de nuevo acerca de esta vieja enfermedad? / Malaria in the world in 2010: What’s new about this old scourge?

El paludismo se mantiene en 2010 como uno de los grandes problemas de salud pública a nivel global. Endémico en 108 países del mundo, causa a día de hoy 250 millones de episodios clínicos y 863 000 muertes anuales, principalmente en el continente africano. El incremento en la última década de los fondos internacionales destinados a financiar actividades de control del paludismo ha condicionado un despliegue sin precedentes de herramientas de control disponibles. Así, millones de redes mosquiteras han sido distribuidas entre las poblaciones más vulnerables de África, y nuevos fármacos más potentes y eficaces han reemplazado en todos los países endémicos a los que habían quedado obsoletos. Como resultado de estos esfuerzos, y por primera vez en muchos años, estamos asistiendo a un cambio en las tendencias epidemiológicas de esta enfermedad, con una disminución de su incidencia global y, como consecuencia, una reducción de su morbimortalidad asociada. Estos progresos han espoleado a la comunidad científica a replantear de nuevo la posibilidad de erradicar esta enfermedad a nivel global. Sin embargo, y a pesar del optimismo imperante, este objetivo será imposible sin la aparición de herramientas de control nuevas y más eficaces, y no parece realista plantearlo a corto plazo. Estos esfuerzos deberán acompañarse de una agenda científica de investigación que sirva a la vez de guía para el diseño de nuevas intervenciones, pero también de mecanismo de monitorización de los progresos obtenidos. Para que el paludismo sea erradicado, también será necesario mantener un compromiso a largo plazo acompañado en paralelo de grandes esfuerzos para reforzar los frágiles sistemas de salud existentes en los países donde la enfermedad es un problema. Este artículo intentará revisar el estado actual del paludismo, en el nuevo contexto de los esfuerzos por su eliminación global (AU)

Malaria remains in 2010 a major global public health problem. The disease is endemic in 108 countries around the world, causing up to 250 million clinical episodes and 863,000 deaths annually, mainly in Africa. In the last decade, the increase of international funding available to finance malaria control activities has conditioned an unprecedented uptake of the different control tools available. Thus, millions of mosquito nets have been distributed among the most vulnerable populations in Africa, and new more potent and effective drugs have replaced those that had become obsolete in most endemic countries. As a result of these efforts, and for the first time in many years, we are witnessing a change in the epidemiology of this disease, with a decrease in its overall impact, and consequently a reduction in its associated morbidity and mortality. These developments have encouraged the scientific community to reconsider the possibility of eradicating the disease globally. However, despite the prevailing optimism, this goal will be impossible without the development of new and more effective control tools, and does not seem realistic to envisage them in the short-term. These efforts must be accompanied by a scientific research agenda that will serve both as a guideline for the design of new interventions, and also as a mechanism for monitoring the progress made. If malaria is to be eradicated, long-term commitments will be necessary, in parallel with greater efforts to strengthen the fragile health systems in countries where the disease is a problem. This article reviews the malaria situation in the light of the current efforts for its global elimination (AU)

Estimating the vaccine-preventable burden of hospitalized pneumonia among young Mozambican children.

Polysaccharide-protein conjugate vaccines against Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae have proven efficacy against radiologically confirmed pneumonia. Measurement of pneumonia incidence provides a platform to estimate of the vaccine-preventable burden. Over 24 months, we conducted surveillance for radiologically confirmed severe pneumonia episodes among children <2 years of age admitted to a rural hospital in Manhiça, southern Mozambique. Study children were tested for HIV during the second year of surveillance. Severe pneumonia accounted for 15% of 5132 hospital admissions and 32% of in-hospital mortality among children <2 years of age. Also, 43% of chest radiographs were interpreted as radiologically confirmed pneumonia. HIV-infection was associated with 81% of fatal pneumonia episodes among children tested for HIV. The minimum incidence rate of radiologically confirmed pneumonia requiring hospitalization was 19 episodes/1000 child-years. Incidence rates among HIV-infected children were 9.3-19.0-fold higher than HIV-uninfected. Introduction of Hib and pneumococcal conjugate vaccines would have a substantial impact on pneumonia hospitalizations among African children if vaccine effects are similar to those observed in clinical trials.

Surveillance of acute bacterial meningitis among children admitted to a district hospital in rural Mozambique.

BACKGROUND: Acute bacterial meningitis (ABM) remains an important cause of mortality among African children. Epidemiologic data with regard to ABM infection are necessary for prioritizing public health interventions. METHODS: We strengthened hospital-based surveillance of ABM among children admitted to Manhiça District Hospital (Maputo, Mozambique). Cerebrospinal fluid (CSF) samples were collected from children admitted to the hospital who met clinical criteria of ABM. Laboratory determinations were performed. Clinical information and outcome of cases were recorded. RESULTS: During the first 12 months of surveillance, which began in January 2006, CSF samples were collected from 642 children <15 years of age with suspected meningitis (18% of all pediatric patients admitted to the hospital during that time). ABM was confirmed in 43 (7%) of the 642 cases. Haemophilus influenzae type b (Hib) (14 cases), pneumococcus (9 cases), and meningococcus (7 cases) represented approximately 70% of confirmed cases. Four of the 9 pneumococci were serotypes covered by the 7-valent pneumococcal conjugate vaccine. The case fatality rate among patients with ABM was 24% (8 of 33 with known outcome); an additional 8 patients left the hospital before discharge. The incidence of ABM was 85 per 100,000 population, which peaked at 2-12 months of age at 1078 cases per 100,000 population. All 9 pneumococci isolates were susceptible to chloramphenicol, and 8 were susceptible to penicillin (the additional 1 had intermediate resistance). For the 10 Hib isolates tested, only 1 was susceptible to chloramphenicol, and 5 were susceptible to ampicillin. CONCLUSION: These data reinforce the importance of ABM as a cause of hospital admission and death in rural sub-Saharan Africa. Most observed ABM cases could have been prevented by current pneumococcal and Hib conjugate vaccines.