Microorganisms Associated With Pneumonia in Children &lt;5 Years of Age in Developing and Emerging Countries: The GABRIEL Pneumonia Multicenter, Prospective, Case-Control Study
Authors: Bénet Thomas , Sánchez Picot Valentina , Messaoudi Mélina , Chou Monidarin , Eap Tekchheng , Wang Jianwei , Shen Kunling , Pape Jean-William , Rouzier Vanessa , Awasthi Shally , Pandey Nitin , Bavdekar Ashish , Sanghavi Sonali , Robinson Annick , Rakoto-Andrianarivelo Mala , Sylla Maryam , Diallo Souleymane , Nymadawa Pagbajabyn , Naranbat Nymadawaagiin , Russomando Graciela , Basualdo Wilma , Komurian-Pradel Florence , Endtz Hubert , Vanhems Philippe , Paranhos-Baccalà Gláucia ,   for the Global Approach to Biological Research, Infectious diseases and Epidemics in Low-income countries (GABRIEL) Network, Espinola Emilio , Guillen Rosa , Chuluunbaatar Maitsetseg , Dash-Yandag Budragchaagiin , Ren Lili , Pechchamnann Visal , Jean Elsie , Thermil Katiana , Dominique Sherlyne , Contamin Bénédicte , Maeder Muriel , Rabezanahary Henintsoa , Diakite Abdoul Aziz , Traore Bréhima , Kawade Anand , Joshi Ruchi , Telles Jean-Noël , Rajoharisan Alain , Hoffmann Jonathan , Goletti Delia , Saha Samir K. , Dagan Ron , Albrich Werner 
Published: May 2017

Abstract

Background
Pneumonia, the leading infectious cause of child mortality globally, mainly afflicts developing countries. This prospective observational study aimed to assess the microorganisms associated with pneumonia in children aged &lt;5 years in developing and emerging countries.

Methods
A multicenter, case-control study by the GABRIEL (Global Approach to Biological Research, Infectious diseases and Epidemics in Low-income countries) network was conducted between 2010 and 2014 in Cambodia, China, Haiti, India (2 sites), Madagascar, Mali, Mongolia, and Paraguay. Cases were hospitalized children with radiologically confirmed pneumonia; controls were children from the same setting without any features suggestive of pneumonia. Nasopharyngeal swabs were collected from all subjects; 19 viruses and 5 bacteria were identified by reverse-transcription polymerase chain reaction. Associations between microorganisms and pneumonia were quantified by calculating the adjusted population attributable fraction (aPAF) after multivariate logistic regression analysis adjusted for sex, age, time period, other pathogens, and site.

Results
Overall, 888 cases and 870 controls were analyzed; ≥1 microorganism was detected in respiratory samples in 93.0% of cases and 74.4% of controls (P &lt; .001). Streptococcus pneumoniae, Mycoplasma pneumoniae, human metapneumovirus, rhinovirus, respiratory syncytial virus (RSV), parainfluenza virus 1, 3, and 4, and influenza virus A and B were independently associated with pneumonia; aPAF was 42.2% (95% confidence interval [CI], 35.5%–48.2%) for S. pneumoniae, 18.2% (95% CI, 17.4%–19.0%) for RSV, and 11.2% (95% CI, 7.5%–14.7%) for rhinovirus.

Conclusions
Streptococcus pneumoniae, RSV, and rhinovirus may be the major microorganisms associated with pneumonia infections in children &lt;5 years of age from developing and emerging countries. Increasing S. pneumoniae vaccination coverage may substantially reduce the burden of pneumonia among children in developing countries.