Pneumonia among young infants in rural Southeast Asia (Bohol Island, Philippines).

OBJECTIVE: To develop a clinical algorithm that can be used to identify pneumonia deaths in young infants in developing countries and estimate the disease burden in this population. PATIENTS AND METHODS: Infants younger than 60 days hospitalized with signs of severe pneumonia who underwent clinical, microbiologic and radiological evaluation were the subjects. Stepwise logistic regression and subtractive iterative process were used to derive the algorithm. RESULTS: Three-hundred and one infants had either clinical or radiographic pneumonia. The case fatality rate for 185 infants with radiographic pneumonia was 21%vs. 5% for clinical pneumonia. Age below 7 days was associated with an increased risk of dying. Among 7- to 59-day-old infants, poor feeding, cyanosis and absence of crackles were predictors of death from pneumonia. Using logistic regression, an algorithm consisting of any one of three clinical signs (cyanosis, poor feeding and abnormally sleepy) was developed in infants aged 7-59 days; 80% of deaths and 50% of those with radiographic pneumonia have at least one of these signs. It performed better than both the WHO case management algorithm and the IMCI algorithm. CONCLUSION: Radiographic pneumonia is a common and serious infection among infants below 2 months old in the Philippines. Cyanosis, poor feeding and abnormal sleepiness are simple signs that can be used by health workers to identify seriously ill infants who are most likely to die from pneumonia.

Serious community-acquired paediatric infections in rural Asia (Bohol Island, Philippines): bacterial meningitis in children less than 5 years of age.

This paper describes the clinical profile and aetiology of bacterial meningitis in infants and children less than 5 y old admitted to a rural general hospital in the Philippines. A total of 989 infants and children 0-59 months old with suspected meningitis using a standardized guideline based on clinical signs and symptoms were prospectively enrolled from April 1994 to May 2000. Blood and CSF were drawn on admission for culture, antigen testing and cell count. All had blood cultures and 623 (63%) had CSF samples. Bacterial aetiology was found in 54 (5%). The most common bacterial pathogens were H. influenzae type b (Hib) (20, 37%) and S. pneumoniae (Pnc) (10, 18%). All of the Hib infections and 8 (80%) Pnc infections were in infants less than 1 y old. 12 (22%) of the subjects with bacterial meningitis died. All strains of S. pneumoniae and H. influenzae were sensitive to chloramphenicol, cotrimoxazole and ampicillin. In conclusion, S. pneumoniae and H. influenzae type b are the most common aetiological agents of bacterial meningitis in a rural area in the Philippines, and occur especially in infants less than 1 y old. Aetiological agents were susceptible to the currently recommended antimicrobial agents.

Immunogenicity and reactogenicity of 23-valent pneumococcal polysaccharide vaccine among pregnant Filipino women and placental transfer of antibodies.

This randomized, controlled study among pregnant women evaluated the prevaccination distribution of anti-pneumococcal (Pnc) antibodies (Ab), the immunogenicity and reactogenicity of Pnc polysaccharide vaccine, and transplacental transfer of Ab. The Pnc vaccine group (N=106) received Pnc PS vaccine, Hemophilus influenzae type b conjugate vaccine and tetanus toxoid; the control group (N=54) received tetanus toxoid only. Sera and cord blood were assayed for anti-pnc Ab using enzyme immunoassay. In the Pnc vaccine group, anti-Pnc Ab rose by 3- to 9-fold and was significantly higher in cord blood. In evaluating Pnc conjugate vaccines, the concentration of 0.35 microg/ml is suggested as the protective threshold against invasive disease. Around 90% of mothers had this level pre-vaccination. Considering the decay of passively acquired Ab and the growth of the infant, an Ab level in cord blood of at least 4.4 microg/ml is needed if infants are to be protected up to 4 months of age. Cord blood anti-Pnc Ab was above this level in 60% and 10% of the Pnc vaccine and control groups, respectively. Maternal immunization with Pnc polysaccharide vaccine can provide prolonged protection through passively acquired Ab.