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Abstract：
BACKGROUND: The Child Health and Mortality Prevention Surveillance (CHAMPS) Network programme undertakes post-mortem minimally invasive tissue sampling (MITS), together with collection of ante-mortem clinical information, to investigate causes of childhood deaths across multiple countries. We aimed to evaluate the overall contribution of pneumonia in the causal pathway to death and the causative pathogens of fatal pneumonia in children aged 1-59 months enrolled in the CHAMPS Network.
METHODS: In this observational study we analysed deaths occurring between Dec 16, 2016, and Dec 31, 2022, in the CHAMPS Network across six countries in sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and one in South Asia (Bangladesh). A standardised approach of MITS was undertaken on decedents within 24-72 h of death. Diagnostic tests included blood culture, multi-organism targeted nucleic acid amplifications tests (NAATs) of blood and lung tissue, and histopathology examination of various organ tissue samples. An interdisciplinary expert panel at each site reviewed case data to attribute the cause of death and pathogenesis thereof on the basis of WHO-recommended reporting standards.
RESULTS: Pneumonia was attributed in the causal pathway of death in 455 (40·6%) of 1120 decedents, with a median age at death of 9 (IQR 4-19) months. Causative pathogens were identified in 377 (82·9%) of 455 pneumonia deaths, and multiple pathogens were implicated in 218 (57·8%) of 377 deaths. 306 (67·3%) of 455 deaths occurred in the community or within 72 h of hospital admission (presumed to be community-acquired pneumonia), with the leading bacterial pathogens being Streptococcus pneumoniae (108 [35·3%]), Klebsiella pneumoniae (78 [25·5%]), and non-typeable Haemophilus influenzae (37 [12·1%]). 149 (32·7%) deaths occurred 72 h or more after hospital admission (presumed to be hospital-acquired pneumonia), with the most common pathogens being K pneumoniae (64 [43·0%]), Acinetobacter baumannii (19 [12·8%]), S pneumoniae (15 [10·1%]), and Pseudomonas aeruginosa (15 [10·1%]). Overall, viruses were implicated in 145 (31·9%) of 455 pneumonia-related deaths, including 54 (11·9%) of 455 attributed to cytomegalovirus and 29 (6·4%) of 455 attributed to respiratory syncytial virus.
CONCLUSIONS: Pneumonia contributed to 40·6% of all childhood deaths in this analysis. The use of post-mortem MITS enabled biological ascertainment of the cause of death in the majority (82·9%) of childhood deaths attributed to pneumonia, with more than one pathogen being commonly implicated in the same case. The prominent role of K pneumoniae, non-typable H influenzae, and S pneumoniae highlight the need to review empirical management guidelines for management of very severe pneumonia in low-income and middle-income settings, and the need for research into new or improved vaccines against these pathogens.
BACKGROUND: Bill & Melinda Gates Foundation.
METHODS: In this observational study we analysed deaths occurring between Dec 16, 2016, and Dec 31, 2022, in the CHAMPS Network across six countries in sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and one in South Asia (Bangladesh). A standardised approach of MITS was undertaken on decedents within 24-72 h of death. Diagnostic tests included blood culture, multi-organism targeted nucleic acid amplifications tests (NAATs) of blood and lung tissue, and histopathology examination of various organ tissue samples. An interdisciplinary expert panel at each site reviewed case data to attribute the cause of death and pathogenesis thereof on the basis of WHO-recommended reporting standards.
RESULTS: Pneumonia was attributed in the causal pathway of death in 455 (40·6%) of 1120 decedents, with a median age at death of 9 (IQR 4-19) months. Causative pathogens were identified in 377 (82·9%) of 455 pneumonia deaths, and multiple pathogens were implicated in 218 (57·8%) of 377 deaths. 306 (67·3%) of 455 deaths occurred in the community or within 72 h of hospital admission (presumed to be community-acquired pneumonia), with the leading bacterial pathogens being Streptococcus pneumoniae (108 [35·3%]), Klebsiella pneumoniae (78 [25·5%]), and non-typeable Haemophilus influenzae (37 [12·1%]). 149 (32·7%) deaths occurred 72 h or more after hospital admission (presumed to be hospital-acquired pneumonia), with the most common pathogens being K pneumoniae (64 [43·0%]), Acinetobacter baumannii (19 [12·8%]), S pneumoniae (15 [10·1%]), and Pseudomonas aeruginosa (15 [10·1%]). Overall, viruses were implicated in 145 (31·9%) of 455 pneumonia-related deaths, including 54 (11·9%) of 455 attributed to cytomegalovirus and 29 (6·4%) of 455 attributed to respiratory syncytial virus.
CONCLUSIONS: Pneumonia contributed to 40·6% of all childhood deaths in this analysis. The use of post-mortem MITS enabled biological ascertainment of the cause of death in the majority (82·9%) of childhood deaths attributed to pneumonia, with more than one pathogen being commonly implicated in the same case. The prominent role of K pneumoniae, non-typable H influenzae, and S pneumoniae highlight the need to review empirical management guidelines for management of very severe pneumonia in low-income and middle-income settings, and the need for research into new or improved vaccines against these pathogens.
BACKGROUND: Bill & Melinda Gates Foundation.
摘要：
背景：儿童健康和死亡率预防监测（CHAMPS）网络计划进行死后微创组织采样（MITS），连同验尸前临床信息的收集，调查多个国家儿童死亡的原因。我们旨在评估CHAMPS网络中1-59个月儿童肺炎在死亡因果途径中的总体贡献以及致命性肺炎的致病病原体。
方法：在这项观察性研究中，我们分析了撒哈拉以南非洲六个国家的CHAMPS网络中2016年12月16日至2022年12月31日之间发生的死亡事件（埃塞俄比亚，肯尼亚,马里,莫桑比克,塞拉利昂，和南非）和一个在南亚（孟加拉国）。对死亡后24-72小时内的死者采取了MITS的标准化方法。诊断检查包括血培养,血液和肺组织的多生物靶向核酸扩增试验（NAAT），和各种器官组织样本的组织病理学检查。每个地点的跨学科专家小组审查了病例数据，以根据世卫组织推荐的报告标准将死亡原因及其发病机制归为原因。
结果：在1120名死者中，455名（40·6％）将肺炎归因于死亡的因果途径，死亡年龄中位数为9个月（IQR4-19）。在455例肺炎死亡病例中，有377例(82·9%)被鉴定出病原体，377例死亡中的218例(57·8%)涉及多种病原体。455例死亡中有306例（67·3％）发生在社区或入院后72小时内（假定为社区获得性肺炎），主要的细菌病原体是肺炎链球菌（108[35·3%]），肺炎克雷伯菌（78[25·5%]），和不可分型的流感嗜血杆菌（37[12·1%]）。149例(32%)死亡发生在入院后72小时或更长时间(推测为医院获得性肺炎)，最常见的病原体是肺炎克雷伯菌(64[43·0%])，鲍曼不动杆菌(19[12·8%])，肺炎链球菌(15[10·1%])，和铜绿假单胞菌(15[10·1%])。总的来说,在455例肺炎相关死亡中，有145例(31·9%)涉及病毒，其中455个中有54个（11·9%）归因于巨细胞病毒，455个中有29个（6·4%）归因于呼吸道合胞病毒。
结论：在这项分析中，肺炎占所有儿童死亡的40%。使用验尸MITS可以从生物学上确定大多数（82·9％）归因于肺炎的儿童死亡原因，同一病例中通常涉及一种以上的病原体。肺炎克雷伯菌的突出作用,不可分型的流感嗜血杆菌，肺炎链球菌强调需要审查低收入和中等收入环境中非常严重的肺炎管理经验管理指南，以及需要研究针对这些病原体的新的或改进的疫苗。
背景：比尔和梅琳达·盖茨基金会。
方法：在这项观察性研究中，我们分析了撒哈拉以南非洲六个国家的CHAMPS网络中2016年12月16日至2022年12月31日之间发生的死亡事件（埃塞俄比亚，肯尼亚,马里,莫桑比克,塞拉利昂，和南非）和一个在南亚（孟加拉国）。对死亡后24-72小时内的死者采取了MITS的标准化方法。诊断检查包括血培养,血液和肺组织的多生物靶向核酸扩增试验（NAAT），和各种器官组织样本的组织病理学检查。每个地点的跨学科专家小组审查了病例数据，以根据世卫组织推荐的报告标准将死亡原因及其发病机制归为原因。
结果：在1120名死者中，455名（40·6％）将肺炎归因于死亡的因果途径，死亡年龄中位数为9个月（IQR4-19）。在455例肺炎死亡病例中，有377例(82·9%)被鉴定出病原体，377例死亡中的218例(57·8%)涉及多种病原体。455例死亡中有306例（67·3％）发生在社区或入院后72小时内（假定为社区获得性肺炎），主要的细菌病原体是肺炎链球菌（108[35·3%]），肺炎克雷伯菌（78[25·5%]），和不可分型的流感嗜血杆菌（37[12·1%]）。149例(32%)死亡发生在入院后72小时或更长时间(推测为医院获得性肺炎)，最常见的病原体是肺炎克雷伯菌(64[43·0%])，鲍曼不动杆菌(19[12·8%])，肺炎链球菌(15[10·1%])，和铜绿假单胞菌(15[10·1%])。总的来说,在455例肺炎相关死亡中，有145例(31·9%)涉及病毒，其中455个中有54个（11·9%）归因于巨细胞病毒，455个中有29个（6·4%）归因于呼吸道合胞病毒。
结论：在这项分析中，肺炎占所有儿童死亡的40%。使用验尸MITS可以从生物学上确定大多数（82·9％）归因于肺炎的儿童死亡原因，同一病例中通常涉及一种以上的病原体。肺炎克雷伯菌的突出作用,不可分型的流感嗜血杆菌，肺炎链球菌强调需要审查低收入和中等收入环境中非常严重的肺炎管理经验管理指南，以及需要研究针对这些病原体的新的或改进的疫苗。
背景：比尔和梅琳达·盖茨基金会。
