Etiology of Clinical Community-Acquired Pneumonia in Swedish Children Aged 1-59 Months with High Pneumococcal Vaccine Coverage-The TREND Study

• Published in: Vaccines (Basel) 2021, Vol.9 (4), p.384
• Main Authors: Eklundh, Annika, Rhedin, Samuel, Ryd-Rinder, Malin, Andersson, Maria, Gantelius, Jesper, Gaudenzi, Giulia, Lindh, Magnus, Peltola, Ville, Waris, Matti, Nauclér, Pontus, Mårtensson, Andreas, Alfvén, Tobias
• Format: Article
• Language: English
• Subjects: Adenoviruses; Algorithms; Antibiotics; Asthma; Bacteria; Bacterial infections; bacterial pneumonia; C-reactive protein; Children; Chronic illnesses; Conjugates; Coronaviruses; diagnosis; Emergency medical care; Etiology; Hospitals; Immunization; Immunologi inom det medicinska området; Immunology; Immunology in the medical area; infection; Infectious Medicine; Infektionsmedicin; Influenza; Medicin och hälsovetenskap; Mortality; Pathogens; Pediatrics; Pleural effusion; pneumococcal conjugate vaccines; Pneumonia; Research & Experimental Medicine; Respiratory diseases; respiratory infection; Respiratory syncytial virus; Streptococcus infections; streptococcus-pneumoniae; Vaccines; viral pneumonia; Viruses; World Health Organization
• ISSN: 2076-393X; 2076-393X
• DOI: 10.3390/vaccines9040384

(1) Immunization with pneumococcal conjugate vaccines has decreased the burden of community-acquired pneumonia (CAP) in children and likely led to a shift in CAP etiology. (2) The Trial of Respiratory infections in children for ENhanced Diagnostics (TREND) enrolled children 1-59 months with clinical CAP according to the World Health Organization (WHO) criteria at Sachs' Children and Youth Hospital, Stockholm, Sweden. Children with rhonchi and indrawing underwent "bronchodilator challenge". C-reactive protein and nasopharyngeal PCR detecting 20 respiratory pathogens, were collected from all children. Etiology was defined according to an a priori defined algorithm based on microbiological, biochemical, and radiological findings. (3) Of 327 enrolled children, 107 (32%) required hospitalization; 91 (28%) received antibiotic treatment; 77 (24%) had a chest X-ray performed; and 60 (18%) responded to bronchodilator challenge. 243 (74%) episodes were classified as viral, 11 (3%) as mixed viral-bacterial, five (2%) as bacterial, two (0.6%) as atypical bacterial and 66 (20%) as undetermined etiology. After exclusion of children responding to bronchodilator challenge, the proportion of bacterial and mixed viral-bacterial etiology was 1% and 4%, respectively. (4) The novel TREND etiology algorithm classified the majority of clinical CAP episodes as of viral etiology, whereas bacterial etiology was uncommon. Defining CAP in children