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Upper Respiratory Tract Co-detection of Human Endemic Coronaviruses and High-density Pneumococcus Associated With Increased Severity Among HIV-Uninfected Children Under 5 Years Old in the PERCH Study.
Pediatr Infect Dis J. 2021 06 01; 40(6):503-512.PI

Abstract

BACKGROUND

Severity of viral respiratory illnesses can be increased with bacterial coinfection and can vary by sex, but influence of coinfection and sex on human endemic coronavirus (CoV) species, which generally cause mild to moderate respiratory illness, is unknown. We evaluated CoV and pneumococcal co-detection by sex in childhood pneumonia.

METHODS

In the 2011-2014 Pneumonia Etiology Research for Child Health study, nasopharyngeal and oropharyngeal (NP/OP) swabs and other samples were collected from 3981 children <5 years hospitalized with severe or very severe pneumonia in 7 countries. Severity by NP/OP detection status of CoV (NL63, 229E, OC43 or HKU1) and high-density (≥6.9 log10 copies/mL) pneumococcus (HDSpn) by real-time polymerase chain reaction was assessed by sex using logistic regression adjusted for age and site.

RESULTS

There were 43 (1.1%) CoV+/HDSpn+, 247 CoV+/HDSpn-, 449 CoV-/HDSpn+ and 3149 CoV-/HDSpn- cases with no significant difference in co-detection frequency by sex (range 51.2%-64.0% male, P = 0.06). More CoV+/HDSpn+ pneumonia was very severe compared with other groups for both males (13/22, 59.1% versus range 29.1%-34.7%, P = 0.04) and females (10/21, 47.6% versus 32.5%-43.5%, P = 0.009), but only male CoV+/HDSpn+ required supplemental oxygen more frequently (45.0% versus 20.6%-28.6%, P < 0.001) and had higher mortality (35.0% versus 5.3%-7.1%, P = 0.004) than other groups. For females with CoV+/HDSpn+, supplemental oxygen was 25.0% versus 24.8%-33.3% (P = 0.58) and mortality was 10.0% versus 9.2%-12.9% (P = 0.69).

CONCLUSIONS

Co-detection of endemic CoV and HDSpn was rare in children hospitalized with pneumonia, but associated with higher severity and mortality in males. Findings may warrant investigation of differences in severity by sex with co-detection of HDSpn and SARS-CoV-2.

Authors+Show Affiliations

From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia.Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Bangladesh.From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.Medical Research Council Unit, Basse, The Gambia. Department of Paediatrics, University of Auckland, New Zealand.Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland.From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Bill & Melinda Gates Foundation, Seattle, Washington.Medical Research Council: Respiratory and Meningeal Pathogens Research Unit. Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa.Department of Pathology and Biomedical Sciences, University of Otago. Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand.From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi, Kenya. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.Department of Global Health and Development, Boston University School of Public Health, Boston, Massachusetts.Medical Research Council Unit, Basse, The Gambia. Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine. Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom.KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi, Kenya.Medical Research Council: Respiratory and Meningeal Pathogens Research Unit.Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.Right to Care-Zambia. Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia.Medical Research Council Unit, Basse, The Gambia. Murdoch Children's Research Institute, Melbourne, Australia. London School of Hygiene and Tropical Medicine, London, United Kingdom. Department of Paediatrics, University of Melbourne, Australia.Medical Research Council: Respiratory and Meningeal Pathogens Research Unit. Department of Paediatrics & Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, South Africa.KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Coast, Kilifi, Kenya. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom. Microbiology Laboratory, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.Department of Global Health and Development, Boston University School of Public Health, Boston, Massachusetts. EQUIP-Zambia, Lusaka, Zambia.National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand.Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Bangladesh.Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Bangladesh.Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali.Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland.From the Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33883479

Citation

Park, Daniel E., et al. "Upper Respiratory Tract Co-detection of Human Endemic Coronaviruses and High-density Pneumococcus Associated With Increased Severity Among HIV-Uninfected Children Under 5 Years Old in the PERCH Study." The Pediatric Infectious Disease Journal, vol. 40, no. 6, 2021, pp. 503-512.
Park DE, Higdon MM, Prosperi C, et al. Upper Respiratory Tract Co-detection of Human Endemic Coronaviruses and High-density Pneumococcus Associated With Increased Severity Among HIV-Uninfected Children Under 5 Years Old in the PERCH Study. Pediatr Infect Dis J. 2021;40(6):503-512.
Park, D. E., Higdon, M. M., Prosperi, C., Baggett, H. C., Brooks, W. A., Feikin, D. R., Hammitt, L. L., Howie, S. R. C., Kotloff, K. L., Levine, O. S., Madhi, S. A., Murdoch, D. R., O'Brien, K. L., Scott, J. A. G., Thea, D. M., Antonio, M., Awori, J. O., Baillie, V. L., Bunthi, C., ... Deloria Knoll, M. (2021). Upper Respiratory Tract Co-detection of Human Endemic Coronaviruses and High-density Pneumococcus Associated With Increased Severity Among HIV-Uninfected Children Under 5 Years Old in the PERCH Study. The Pediatric Infectious Disease Journal, 40(6), 503-512. https://doi.org/10.1097/INF.0000000000003139
Park DE, et al. Upper Respiratory Tract Co-detection of Human Endemic Coronaviruses and High-density Pneumococcus Associated With Increased Severity Among HIV-Uninfected Children Under 5 Years Old in the PERCH Study. Pediatr Infect Dis J. 2021 06 1;40(6):503-512. PubMed PMID: 33883479.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Upper Respiratory Tract Co-detection of Human Endemic Coronaviruses and High-density Pneumococcus Associated With Increased Severity Among HIV-Uninfected Children Under 5 Years Old in the PERCH Study. AU - Park,Daniel E, AU - Higdon,Melissa M, AU - Prosperi,Christine, AU - Baggett,Henry C, AU - Brooks,W Abdullah, AU - Feikin,Daniel R, AU - Hammitt,Laura L, AU - Howie,Steve R C, AU - Kotloff,Karen L, AU - Levine,Orin S, AU - Madhi,Shabir A, AU - Murdoch,David R, AU - O'Brien,Katherine L, AU - Scott,J Anthony G, AU - Thea,Donald M, AU - Antonio,Martin, AU - Awori,Juliet O, AU - Baillie,Vicky L, AU - Bunthi,Charatdao, AU - Kwenda,Geoffrey, AU - Mackenzie,Grant A, AU - Moore,David P, AU - Morpeth,Susan C, AU - Mwananyanda,Lawrence, AU - Paveenkittiporn,Wantana, AU - Ziaur Rahman,Mohammed, AU - Rahman,Mustafizur, AU - Rhodes,Julia, AU - Sow,Samba O, AU - Tapia,Milagritos D, AU - Deloria Knoll,Maria, PY - 2021/4/23/pubmed PY - 2021/4/23/medline PY - 2021/4/22/entrez SP - 503 EP - 512 JF - The Pediatric infectious disease journal JO - Pediatr Infect Dis J VL - 40 IS - 6 N2 - BACKGROUND: Severity of viral respiratory illnesses can be increased with bacterial coinfection and can vary by sex, but influence of coinfection and sex on human endemic coronavirus (CoV) species, which generally cause mild to moderate respiratory illness, is unknown. We evaluated CoV and pneumococcal co-detection by sex in childhood pneumonia. METHODS: In the 2011-2014 Pneumonia Etiology Research for Child Health study, nasopharyngeal and oropharyngeal (NP/OP) swabs and other samples were collected from 3981 children <5 years hospitalized with severe or very severe pneumonia in 7 countries. Severity by NP/OP detection status of CoV (NL63, 229E, OC43 or HKU1) and high-density (≥6.9 log10 copies/mL) pneumococcus (HDSpn) by real-time polymerase chain reaction was assessed by sex using logistic regression adjusted for age and site. RESULTS: There were 43 (1.1%) CoV+/HDSpn+, 247 CoV+/HDSpn-, 449 CoV-/HDSpn+ and 3149 CoV-/HDSpn- cases with no significant difference in co-detection frequency by sex (range 51.2%-64.0% male, P = 0.06). More CoV+/HDSpn+ pneumonia was very severe compared with other groups for both males (13/22, 59.1% versus range 29.1%-34.7%, P = 0.04) and females (10/21, 47.6% versus 32.5%-43.5%, P = 0.009), but only male CoV+/HDSpn+ required supplemental oxygen more frequently (45.0% versus 20.6%-28.6%, P < 0.001) and had higher mortality (35.0% versus 5.3%-7.1%, P = 0.004) than other groups. For females with CoV+/HDSpn+, supplemental oxygen was 25.0% versus 24.8%-33.3% (P = 0.58) and mortality was 10.0% versus 9.2%-12.9% (P = 0.69). CONCLUSIONS: Co-detection of endemic CoV and HDSpn was rare in children hospitalized with pneumonia, but associated with higher severity and mortality in males. Findings may warrant investigation of differences in severity by sex with co-detection of HDSpn and SARS-CoV-2. SN - 1532-0987 UR - https://www.unboundmedicine.com/medline/citation/33883479/Upper_Respiratory_Tract_Co_detection_of_Human_Endemic_Coronaviruses_and_High_density_Pneumococcus_Associated_With_Increased_Severity_Among_HIV_Uninfected_Children_Under_5_Years_Old_in_the_PERCH_Study_ L2 - https://doi.org/10.1097/INF.0000000000003139 DB - PRIME DP - Unbound Medicine ER -