Nasopharyngeal secretions and throat-swab specimens from 809 children less than 6 years old with acute respiratory infection were examined by culture and indirect immunofluorescence for the presence of virus or viral antigen. Blood was cultured for the presence of bacteria in selected cases of lower respiratory infection (LRI); pleural fluid also was cultured in cases of empyema. Viruses were detected in 163 (49%) of 331 children with LRI. Respiratory syncytial virus (RSV) was the commonest agent isolated (106 children). Other viruses isolated included parainfluenza viruses (36 children), adenoviruses (12), and influenza viruses (five). Outbreaks of infection due to RSV occurred during August through October. Pneumonia was the commonest LRI encountered (178 children). Among children with pneumonia, viruses were detected in 65 (37%) of 178 children, and bacteria were isolated from 27 (18%) of the 147 children for whom blood cultures were done. Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus were the common bacterial pathogens isolated. In cases of empyema and pyopneumothorax, S. aureus was the commonest organism isolated. There were 116 children with bronchiolitis, 83 (72%) of whom had viral infections; the majority of these children (81%) had RSV infection. Croup was uncommon (eight cases) and was caused mainly by parainfluenza viruses.

Acute Disease↗

PubMedDate not supplied

Haemophilus influenzae disease and immunization in developing countries.

Haemophilus influenzae is one of the leading causes of severe bacterial infection in children of developing regions, causing 30% of the cases of culture-positive pneumonia and 20%-60% of the cases of bacterial meningitis. In infants and children, the majority of isolates from cerebrospinal fluid and blood and 16%-38% of pulmonary isolates are H. influenzae type b. The availability of several new polysaccharide-protein conjugate vaccines for the prevention of invasive disease due to H. influenzae type b prompts this review of the epidemiology of H. influenzae disease in the developing world and of the characteristics of current H. influenzae type b vaccines. To develop a strategy for use of H. influenzae type b vaccines in developing countries, the following data are needed: the age-specific attack rates of H. influenzae type b disease and the immunogenicity and efficacy of these vaccines in young infants in developing countries. Should H. influenzae type b vaccines prove to be inadequate for the prevention of H. influenzae pneumonia, the use of non-type b H. influenzae vaccines may be necessary.

Bacterial Capsules↗

PubMedDate not supplied

Viral vaccines for the prevention of childhood pneumonia in developing nations: priorities and prospects.

In concert with bacteria, respiratory viruses play a major role in the high rates of acute lower respiratory infection (ALRI) experienced in developing nations. Respiratory syncytial virus, parainfluenza and influenza viruses, and the adenoviruses are the predominant viral causes of ALRI in both developed and developing regions. In this review, the epidemiologic data from developing nations for these viral infections are summarized and the current status of viral vaccines for prevention of ALRI are described. Among the questions to be addressed before these vaccines are used in developing nations are (1) the age-specific rates of infection and disease, (2) the effect of high-dose early exposure to these viruses, and (3) the effect of malnutrition on the immunogenicity of the vaccines. Prospective family studies and other community-based approaches will be required in the acquisition of these data.

Adenovirus Infections, Human↗