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首页> 外文期刊>Pneumonia. >Childhood pneumonia and meningitis in the Eastern Highlands Province, Papua New Guinea in the era of conjugate vaccines: study methods and challenges
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Childhood pneumonia and meningitis in the Eastern Highlands Province, Papua New Guinea in the era of conjugate vaccines: study methods and challenges

机译：结合疫苗时代巴布亚新几内亚东部高地省的儿童肺炎和脑膜炎：研究方法和挑战

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BackgroundPneumonia and meningitis are common causes of severe childhood illness in Papua New Guinea (PNG). The etiology of both clinical conditions in PNG has not been recently assessed. Changes in lifestyle, provision and access to healthcare, antimicrobial utilization and resistance, and the national childhood vaccination schedule necessitate reassessment. MethodsA prospective case-control study was undertaken, enrolling children Results998 cases and 978 controls were enrolled over 3?years. This included 784 cases (78.6%) with moderate pneumonia, 187 (18.7%) with severe pneumonia and 75 (7.5%) with suspected meningitis, of whom 48 (4.8%) had concurrent pneumonia. The median age of cases was 7.8?months (Interquartile range [IQR] 3.9–14.3), significantly lower than community controls, which was 20.8?months (IQR 8.2–36.4). Half the cases were admitted to hospital (500/998; 50.1%). Recruitment of cases and controls and successful collection of diagnostic specimens improved throughout the study, with blood volume increasing and rates of blood culture contamination decreasing. The overall case fatality rate was 18/998 (1.8%). Of cases eligible for follow-up, outcome data was available from 76.7%. Low but increasing coverage of Haemophilus influenzae type B conjugate vaccines on the national schedule was observed during the study period: three dose DTPw-HepB-Hib coverage in children >3?months increased from 14.9 to 43.0% and 29.0 to 47.7% in cases and controls (both p 3?months was only 4.0 and 6.5%. ConclusionsRecruitment of large numbers of pediatric pneumonia and meningitis cases and community controls in a third-world setting presents unique challenges. Successful enrolment of 998 cases and 978 controls with comprehensive clinical data, biological specimens and follow up was achieved. Increased vaccine coverage remains an ongoing health priority.
机译：背景肺炎和脑膜炎是巴布亚新几内亚（PNG）严重的儿童疾病的常见原因。最近尚未评估PNG两种临床病因的病因。生活方式，提供和获得医疗保健服务的改变，抗菌素的利用和耐药性以及全国儿童疫苗接种时间表的改变，都需要重新评估。方法进行一项前瞻性病例对照研究，纳入儿童结果998例和978例3岁以上儿童。其中包括784例（78.6％）中度肺炎，187例（18.7％）重度肺炎和75例（7.5％）疑似脑膜炎，其中48例（4.8％）并发肺炎。病例的中位年龄为7.8个月（四分位间距[IQR] 3.9-14.3），明显低于社区控制的20.8个月（IQR 8.2-36.4）。一半的病例入院（500/998; 50.1％）。在整个研究过程中，病例和对照的招募以及诊断标本的成功收集得到了改善，血液量增加，血液培养物污染率降低。总体病死率为18/998（1.8％）。在符合随访条件的病例中，可从76.7％获得结果数据。在研究期间，观察到国家计划中的乙型流感嗜血杆菌结合疫苗覆盖率较低，但仍在增加：在3个月以上儿童中，三剂DTPw-HepB-Hib覆盖率分别从14.9％增至43.0％和29.0％增至47.7％。对照组（p 3个月）分别为4.0％和6.5％。结论在第三世界地区招募大量小儿肺炎和脑膜炎病例以及社区控制提出了独特的挑战。成功纳入998例病例和978例对照患者并获得全面的临床数据，生物标本和后续措施已经实现，扩大疫苗覆盖率仍然是健康方面的首要任务。

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