Epidemiology and Etiology of Hospitalized Pneumonia in Children

Summary

Principal Investigator: Krow Ampofo
Abstract: Pneumonia in children is a major cause of morbidity and mortality worldwide and the leading cause of death in children younger than 5 years of age worldwide. Among children in the United States, pneumonia and influenza are the eighth leading causes of death. Although the burden of pneumonia in children is well appreciated, recent data on the incidence and etiology of pneumonia in children are few. Moreover, the epidemiology of childhood pneumonia is changing due to the impact of Haemophilus influenzae type b (Hib) vaccine and pneumococcal conjugate vaccine, and the emergence of non-vaccine serotypes of Streptococcus pneumioniae and highly virulent clones of methcillin resistant Staphylococcus aureus (MRSA). Several respiratory viruses have been recognized in recent years, and there is increased recognition of the impact of influenza in causing primary pneumonia as well as life-threatening secondary infections. Determining the true etiology of pneumonia has been difficult. The primary reasons for this are: 1) the large number of bacterial and viral agents that may cause pneumonia;2) the frequency of viral and bacterial co- infections;3) the limited availability of deep respiratory specimens from children;4) the limitations of current laboratory technology;and 5) antibiotic therapy initiated before microbiological evaluation. These limitations result in empirical clinical management of children with pneumonia. The optimum management of pediatric pneumonia is dependent on understanding the epidemiology of the pathogens that cause pneumonia by age and geographic region. The University of Utah, in collaboration with the Associated and Regional University Pathologists Laboratories and Research Enterprise, as well as Idaho Technology, Inc., is uniquely suited to address this problem. We have been performing population-based studies of respiratory infections in Salt Lake County, a region with one of the highest birth rates in the US, have outstanding information technology resources, and have extensive experience with standard and novel molecular diagnostic tests. The Specific Aims of this proposal are: Specific Aim 1: Identify all children (1 week to 18 years of age) residing in Salt Lake County hospitalized for clinically diagnosed and radiologically-confirmed, community-acquired pneumonia. Enroll all children meeting a strict case definition (estimated number >500/year) into a prospective clinical study to determine the incidence, etiology and outcomes of pneumonia among hospitalized children, using state of the art diagnostic methods. Specific Aim 2: Determine the incidence, etiology and outcomes of pediatric influenza-associated pneumonia in Salt Lake County, including primary viral pneumonia, viral and bacterial co-infection, and post-influenza bacterial pneumonia. Specific Aim 3: Document the etiology of pediatric pneumonia due to established and emerging pathogens using molecular analysis and a novel diagnostic platform. a. Improve the ability to identify the etiology of presumed bacterial infection using molecular analysis of pleural fluid and blood. b. Expand the range of pathogens evaluated as potential causes of hospitalized pediatric pneumonia to include emerging viruses such as non-SARS coronaviruses, parainfluenza virus 4 (PIV 4) human metapneumovirus, rhinoviruses, and bocavirus. The successful achievement of these Specific Aims will allow us to determine the incidence and etiology of pediatric hospitalized pneumonia and to further understand the complications associated with influenza. PUBLIC HEALTH RELEVANCE: Our study, Epidemiology and Etiology of Hospitalized Pneumonia in Children, supports and addresses the National Center for Immunization and Respiratory Diseases (NCIRD) of CDC objectives of "Healthy People 2010" to prevent disease, disability, and death from infectious diseases, including vaccine-preventable diseases to protect Americans from infectious diseases. It will lead to improved understanding of the spectrum of viruses and bacteria responsible for pneumonia will aid in appropriate choices of antimicrobial therapy. Understanding the frequency and etiology of bacterial infections following influenza will aid in pandemic planning. The data obtained from the proposed studies will be vital for evidence-based management of pneumonia in children.
Funding Period: -------------------- - --------------------
more information: NIH RePORT

Top Publications

  1. ncbi Development of levofloxacin inhalation solution to treat Pseudomonas aeruginosa in patients with cystic fibrosis
    Chris Stockmann
    University of Utah Health Sciences Center, 295 Chipeta Way, Clinical Pharmacology, Salt Lake City, UT 84108, USA
    Ther Adv Respir Dis 8:13-21. 2014
  2. pmc Invasive pneumococcal disease in infants younger than 90 days before and after introduction of PCV7
    Liset Olarte
    Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT, USA
    Pediatrics 132:e17-24. 2013
  3. pmc Characteristics of antimicrobial studies registered in the USA through ClinicalTrials.Gov
    Chris Stockmann
    Department of Paediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
    Int J Antimicrob Agents 42:161-6. 2013
  4. ncbi Infectious disease issues in adoption of young children
    Krow Ampofo
    Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah 84108, USA
    Curr Opin Pediatr 25:78-87. 2013
  5. pmc Seasonality of acute otitis media and the role of respiratory viral activity in children
    Chris Stockmann
    Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah Health Sciences Center, Salt Lake City, UT, USA
    Pediatr Infect Dis J 32:314-9. 2013
  6. pmc Evolving epidemiologic characteristics of invasive group a streptococcal disease in Utah, 2002-2010
    Chris Stockmann
    Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, 84108, USA
    Clin Infect Dis 55:479-87. 2012
  7. pmc The changing epidemiology of invasive pneumococcal disease at a tertiary children's hospital through the 7-valent pneumococcal conjugate vaccine era: a case for continuous surveillance
    Krow Ampofo
    Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT 84108, USA
    Pediatr Infect Dis J 31:228-34. 2012
  8. pmc Therapeutic monitoring of voriconazole in children less than three years of age: a case report and summary of voriconazole concentrations for ten children
    Elizabeth H Doby
    Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
    Pediatr Infect Dis J 31:632-5. 2012
  9. pmc Increasing incidence of invasive Haemophilus influenzae disease in adults, Utah, USA
    Matthew P Rubach
    University of Utah, Salt Lake City, Utah, USA
    Emerg Infect Dis 17:1645-50. 2011
  10. pmc Non-invasive sample collection for respiratory virus testing by multiplex PCR
    Anne J Blaschke
    University of Utah, Department of Pediatrics, Salt Lake City, UT 84108, USA
    J Clin Virol 52:210-4. 2011

Scientific Experts

  • Anne J Blaschke
  • Krow Ampofo
  • DAVID JAMES SHARP
  • Matthew P Rubach
  • Chris Stockmann
  • Andrew T Pavia
  • Carrie L Byington
  • Adam L Hersh
  • Michael G Spigarelli
  • Catherine M T Sherwin
  • Liset Olarte
  • Robert M Ward
  • Kent Korgenski
  • Elizabeth H Doby
  • Metha Apiwattanakul
  • Jeffrey J Ekstrand
  • Judy A Daly
  • Xiaoming Sheng
  • Scott T Carleton
  • Edward O Mason
  • Paul L Martin
  • Judy Daly
  • Harry R Hill
  • Daniel K Benjamin
  • Brian A Kendall
  • Timothy A Driscoll
  • Michael Cohen-Wolkowiez
  • Cassandra Moran
  • Joshua L Bonkowsky
  • Julia Rawlings
  • Andrew McKeon
  • Adam F Carpenter
  • Gary M Miller
  • Marcelo Matiello
  • Vanda A Lennon
  • Claudia F Lucchinetti
  • Sean J Pittock
  • Beth Turney
  • Bogdan F Popescu
  • Brian G Weinshenker
  • Amy Herbener
  • E Kent Korgenski

Detail Information

Publications17

  1. ncbi Development of levofloxacin inhalation solution to treat Pseudomonas aeruginosa in patients with cystic fibrosis
    Chris Stockmann
    University of Utah Health Sciences Center, 295 Chipeta Way, Clinical Pharmacology, Salt Lake City, UT 84108, USA
    Ther Adv Respir Dis 8:13-21. 2014
    ....
  2. pmc Invasive pneumococcal disease in infants younger than 90 days before and after introduction of PCV7
    Liset Olarte
    Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT, USA
    Pediatrics 132:e17-24. 2013
    ..We evaluated the changes that occurred after PCV7 introduction among Utah infants aged 1 to 90 days, too young to be fully immunized...
  3. pmc Characteristics of antimicrobial studies registered in the USA through ClinicalTrials.Gov
    Chris Stockmann
    Department of Paediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
    Int J Antimicrob Agents 42:161-6. 2013
    ..Leveraging the application of these data to guide the careful selection of antimicrobial agents will be essential to preserve their utility for years to come. ..
  4. ncbi Infectious disease issues in adoption of young children
    Krow Ampofo
    Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah 84108, USA
    Curr Opin Pediatr 25:78-87. 2013
    ..To provide an update and overview of infectious disease issues in children of international adoption...
  5. pmc Seasonality of acute otitis media and the role of respiratory viral activity in children
    Chris Stockmann
    Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah Health Sciences Center, Salt Lake City, UT, USA
    Pediatr Infect Dis J 32:314-9. 2013
    ..AOM and respiratory viruses both display seasonal variation. Our objective was to examine the temporal association between circulating respiratory viruses and the occurrence of pediatric ambulatory care visits for AOM...
  6. pmc Evolving epidemiologic characteristics of invasive group a streptococcal disease in Utah, 2002-2010
    Chris Stockmann
    Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, 84108, USA
    Clin Infect Dis 55:479-87. 2012
    ..Invasive group A Streptococcus (GAS) infections are associated with substantial morbidity and mortality. Recent national surveillance data report stable rates of invasive GAS disease, although these may not capture geographic variation...
  7. pmc The changing epidemiology of invasive pneumococcal disease at a tertiary children's hospital through the 7-valent pneumococcal conjugate vaccine era: a case for continuous surveillance
    Krow Ampofo
    Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT 84108, USA
    Pediatr Infect Dis J 31:228-34. 2012
    ..We recognized an opportunity to describe the changes in epidemiology, clinical syndromes, and serotype distribution during a 14-year period including 4 years before vaccine introduction and spanning the entire PCV7 era...
  8. pmc Therapeutic monitoring of voriconazole in children less than three years of age: a case report and summary of voriconazole concentrations for ten children
    Elizabeth H Doby
    Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
    Pediatr Infect Dis J 31:632-5. 2012
    ..Trough concentrations were unpredictable based on dose, highlighting the need to follow values during therapy...
  9. pmc Increasing incidence of invasive Haemophilus influenzae disease in adults, Utah, USA
    Matthew P Rubach
    University of Utah, Salt Lake City, Utah, USA
    Emerg Infect Dis 17:1645-50. 2011
    ..The case-fatality rate was 22%. The incidence of invasive H. influenzae in Utah adults appears to be increasing. Invasive H. influenzae infection disproportionately affected the elderly and was associated with a high mortality rate...
  10. pmc Non-invasive sample collection for respiratory virus testing by multiplex PCR
    Anne J Blaschke
    University of Utah, Department of Pediatrics, Salt Lake City, UT 84108, USA
    J Clin Virol 52:210-4. 2011
    ..Identifying respiratory pathogens within populations is difficult because invasive sample collection, such as with nasopharyngeal aspirate (NPA), is generally required. PCR technology could allow for non-invasive sampling methods...
  11. pmc Interpreting assays for the detection of Streptococcus pneumoniae
    Anne J Blaschke
    Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah 84158, USA
    Clin Infect Dis 52:S331-7. 2011
    ..Here we will discuss the challenges faced in the interpretation of molecular testing for S. pneumoniae, and some strategies that might be used to improve our ability to diagnose pneumococcal respiratory infection...
  12. pmc Molecular analysis improves pathogen identification and epidemiologic study of pediatric parapneumonic empyema
    Anne J Blaschke
    Department of Pediatrics, University of Utah, Salt, Lake City, UT, USA
    Pediatr Infect Dis J 30:289-94. 2011
    ..Epidemiologic study is complicated by the low frequency of positive cultures. We sought to describe the epidemiology of PPE in children using molecular analysis of pleural fluid...
  13. ncbi Intractable vomiting as the initial presentation of neuromyelitis optica
    Metha Apiwattanakul
    Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
    Ann Neurol 68:757-61. 2010
    ..Our clinical, pathologic and neuroimaging observations suggest the aquaporin-4-rich area postrema may be a first point of attack in neuromyelitis optica...
  14. ncbi Heightened neurologic complications in children with pandemic H1N1 influenza
    Jeffrey J Ekstrand
    Division of Pediatric Neurology, University of Utah School of Medicine, Salt Lake City, UT 84108, USA
    Ann Neurol 68:762-6. 2010
    ..In addition, we noted a trend toward heightened neurological complications following second wave influenza activity...
  15. ncbi Increased frontoparietal integration after stroke and cognitive recovery
    David J Sharp
    Division of Neuroscience and Mental Health, Imperial College London, Hammersmith Hospital Campus, London, UK
    Ann Neurol 68:753-6. 2010
    ..This change reflects greater top-down control of speech comprehension and provides a mechanism by which language impairments after stroke may be compensated for...
  16. pmc Association of 2009 pandemic influenza A (H1N1) infection and increased hospitalization with parapneumonic empyema in children in Utah
    Krow Ampofo
    Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT, USA
    Pediatr Infect Dis J 29:905-9. 2010
    ..We examined the relationship between circulating 2009 H1N1 and the occurrence of secondary bacterial parapneumonic empyema in children...