Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA)

an observational cohort study

Samir K. Saha, Stephanie J. Schrag, Shams El Arifeen, Luke C. Mullany, Mohammad Shahidul Islam, Nong Shang, Shamim A. Qazi, Anita K.M. Zaidi, Zulfiqar A. Bhutta, Anuradha Bose, Pinaki Panigrahi, Sajid B. Soofi, Nicholas E. Connor, Dipak K. Mitra, Rita Isaac, Jonas M. Winchell, Melissa L. Arvay, Maksuda Islam, Yasir Shafiq, Imran Nisar & 35 others Benazir Baloch, Furqan Kabir, Murtaza Ali, Maureen H. Diaz, Radhanath Satpathy, Pritish Nanda, Bijaya K. Padhi, Sailajanandan Parida, Aneeta Hotwani, M. Hasanuzzaman, Sheraz Ahmed, Mohammad Belal Hossain, Shabina Ariff, Imran Ahmed, Syed Mamun Ibne Moin, Arif Mahmud, Jessica L. Waller, Iftekhar Rafiqullah, Mohammad A. Quaiyum, Nazma Begum, Veeraraghavan Balaji, Jasmin Halen, A. S.M. Nawshad Uddin Ahmed, Martin W. Weber, Davidson H. Hamer, Patricia L. Hibberd, Qazi Sadeq-ur Rahman, Venkat Raghava Mogan, Tanvir Hossain, Lesley McGee, Shalini Anandan, Anran Liu, Kalpana Panigrahi, Asha Mary Abraham, Abdullah H. Baqui

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: More than 500 000 neonatal deaths per year result from possible serious bacterial infections (pSBIs), but the causes are largely unknown. We investigated the incidence of community-acquired infections caused by specific organisms among neonates in south Asia. Methods: From 2011 to 2014, we identified babies through population-based pregnancy surveillance at five sites in Bangladesh, India, and Pakistan. Babies were visited at home by community health workers up to ten times from age 0 to 59 days. Illness meeting the WHO definition of pSBI and randomly selected healthy babies were referred to study physicians. The primary objective was to estimate proportions of specific infectious causes by blood culture and Custom TaqMan Array Cards molecular assay (Thermo Fisher, Bartlesville, OK, USA) of blood and respiratory samples. Findings: 6022 pSBI episodes were identified among 63 114 babies (95·4 per 1000 livebirths). Causes were attributed in 28% of episodes (16% bacterial and 12% viral). Mean incidence of bacterial infections was 13·2 (95% credible interval [CrI] 11·2–15·6) per 1000 livebirths and of viral infections was 10·1 (9·4–11·6) per 1000 livebirths. The leading pathogen was respiratory syncytial virus (5·4, 95% CrI 4·8–6·3 episodes per 1000 livebirths), followed by Ureaplasma spp (2·4, 1·6–3·2 episodes per 1000 livebirths). Among babies who died, causes were attributed to 46% of pSBI episodes, among which 92% were bacterial. 85 (83%) of 102 blood culture isolates were susceptible to penicillin, ampicillin, gentamicin, or a combination of these drugs. Interpretation: Non-attribution of a cause in a high proportion of patients suggests that a substantial proportion of pSBI episodes might not have been due to infection. The predominance of bacterial causes among babies who died, however, indicates that appropriate prevention measures and management could substantially affect neonatal mortality. Susceptibility of bacterial isolates to first-line antibiotics emphasises the need for prudent and limited use of newer-generation antibiotics. Furthermore, the predominance of atypical bacteria we found and high incidence of respiratory syncytial virus indicated that changes in management strategies for treatment and prevention are needed. Given the burden of disease, prevention of respiratory syncytial virus would have a notable effect on the overall health system and achievement of Sustainable Development Goal. Funding: Bill & Melinda Gates Foundation

Original languageEnglish (US)
Pages (from-to)145-159
Number of pages15
JournalThe Lancet
Volume392
Issue number10142
DOIs
StatePublished - Jul 14 2018

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Community-Acquired Infections
Bacterial Infections
Observational Studies
Cohort Studies
Respiratory Syncytial Viruses
Incidence
Ureaplasma
Anti-Bacterial Agents
Bangladesh
Pakistan
Conservation of Natural Resources
Infant Mortality
Virus Diseases
Drug Combinations
Ampicillin
Gentamicins
Penicillins
India
Newborn Infant
Bacteria

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Saha, S. K., Schrag, S. J., El Arifeen, S., Mullany, L. C., Shahidul Islam, M., Shang, N., ... Baqui, A. H. (2018). Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA): an observational cohort study. The Lancet, 392(10142), 145-159. https://doi.org/10.1016/S0140-6736(18)31127-9

Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA) : an observational cohort study. / Saha, Samir K.; Schrag, Stephanie J.; El Arifeen, Shams; Mullany, Luke C.; Shahidul Islam, Mohammad; Shang, Nong; Qazi, Shamim A.; Zaidi, Anita K.M.; Bhutta, Zulfiqar A.; Bose, Anuradha; Panigrahi, Pinaki; Soofi, Sajid B.; Connor, Nicholas E.; Mitra, Dipak K.; Isaac, Rita; Winchell, Jonas M.; Arvay, Melissa L.; Islam, Maksuda; Shafiq, Yasir; Nisar, Imran; Baloch, Benazir; Kabir, Furqan; Ali, Murtaza; Diaz, Maureen H.; Satpathy, Radhanath; Nanda, Pritish; Padhi, Bijaya K.; Parida, Sailajanandan; Hotwani, Aneeta; Hasanuzzaman, M.; Ahmed, Sheraz; Belal Hossain, Mohammad; Ariff, Shabina; Ahmed, Imran; Ibne Moin, Syed Mamun; Mahmud, Arif; Waller, Jessica L.; Rafiqullah, Iftekhar; Quaiyum, Mohammad A.; Begum, Nazma; Balaji, Veeraraghavan; Halen, Jasmin; Nawshad Uddin Ahmed, A. S.M.; Weber, Martin W.; Hamer, Davidson H.; Hibberd, Patricia L.; Sadeq-ur Rahman, Qazi; Mogan, Venkat Raghava; Hossain, Tanvir; McGee, Lesley; Anandan, Shalini; Liu, Anran; Panigrahi, Kalpana; Abraham, Asha Mary; Baqui, Abdullah H.

In: The Lancet, Vol. 392, No. 10142, 14.07.2018, p. 145-159.

Research output: Contribution to journalArticle

Saha, SK, Schrag, SJ, El Arifeen, S, Mullany, LC, Shahidul Islam, M, Shang, N, Qazi, SA, Zaidi, AKM, Bhutta, ZA, Bose, A, Panigrahi, P, Soofi, SB, Connor, NE, Mitra, DK, Isaac, R, Winchell, JM, Arvay, ML, Islam, M, Shafiq, Y, Nisar, I, Baloch, B, Kabir, F, Ali, M, Diaz, MH, Satpathy, R, Nanda, P, Padhi, BK, Parida, S, Hotwani, A, Hasanuzzaman, M, Ahmed, S, Belal Hossain, M, Ariff, S, Ahmed, I, Ibne Moin, SM, Mahmud, A, Waller, JL, Rafiqullah, I, Quaiyum, MA, Begum, N, Balaji, V, Halen, J, Nawshad Uddin Ahmed, ASM, Weber, MW, Hamer, DH, Hibberd, PL, Sadeq-ur Rahman, Q, Mogan, VR, Hossain, T, McGee, L, Anandan, S, Liu, A, Panigrahi, K, Abraham, AM & Baqui, AH 2018, 'Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA): an observational cohort study', The Lancet, vol. 392, no. 10142, pp. 145-159. https://doi.org/10.1016/S0140-6736(18)31127-9
Saha, Samir K. ; Schrag, Stephanie J. ; El Arifeen, Shams ; Mullany, Luke C. ; Shahidul Islam, Mohammad ; Shang, Nong ; Qazi, Shamim A. ; Zaidi, Anita K.M. ; Bhutta, Zulfiqar A. ; Bose, Anuradha ; Panigrahi, Pinaki ; Soofi, Sajid B. ; Connor, Nicholas E. ; Mitra, Dipak K. ; Isaac, Rita ; Winchell, Jonas M. ; Arvay, Melissa L. ; Islam, Maksuda ; Shafiq, Yasir ; Nisar, Imran ; Baloch, Benazir ; Kabir, Furqan ; Ali, Murtaza ; Diaz, Maureen H. ; Satpathy, Radhanath ; Nanda, Pritish ; Padhi, Bijaya K. ; Parida, Sailajanandan ; Hotwani, Aneeta ; Hasanuzzaman, M. ; Ahmed, Sheraz ; Belal Hossain, Mohammad ; Ariff, Shabina ; Ahmed, Imran ; Ibne Moin, Syed Mamun ; Mahmud, Arif ; Waller, Jessica L. ; Rafiqullah, Iftekhar ; Quaiyum, Mohammad A. ; Begum, Nazma ; Balaji, Veeraraghavan ; Halen, Jasmin ; Nawshad Uddin Ahmed, A. S.M. ; Weber, Martin W. ; Hamer, Davidson H. ; Hibberd, Patricia L. ; Sadeq-ur Rahman, Qazi ; Mogan, Venkat Raghava ; Hossain, Tanvir ; McGee, Lesley ; Anandan, Shalini ; Liu, Anran ; Panigrahi, Kalpana ; Abraham, Asha Mary ; Baqui, Abdullah H. / Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA) : an observational cohort study. In: The Lancet. 2018 ; Vol. 392, No. 10142. pp. 145-159.
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title = "Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA): an observational cohort study",
abstract = "Background: More than 500 000 neonatal deaths per year result from possible serious bacterial infections (pSBIs), but the causes are largely unknown. We investigated the incidence of community-acquired infections caused by specific organisms among neonates in south Asia. Methods: From 2011 to 2014, we identified babies through population-based pregnancy surveillance at five sites in Bangladesh, India, and Pakistan. Babies were visited at home by community health workers up to ten times from age 0 to 59 days. Illness meeting the WHO definition of pSBI and randomly selected healthy babies were referred to study physicians. The primary objective was to estimate proportions of specific infectious causes by blood culture and Custom TaqMan Array Cards molecular assay (Thermo Fisher, Bartlesville, OK, USA) of blood and respiratory samples. Findings: 6022 pSBI episodes were identified among 63 114 babies (95·4 per 1000 livebirths). Causes were attributed in 28{\%} of episodes (16{\%} bacterial and 12{\%} viral). Mean incidence of bacterial infections was 13·2 (95{\%} credible interval [CrI] 11·2–15·6) per 1000 livebirths and of viral infections was 10·1 (9·4–11·6) per 1000 livebirths. The leading pathogen was respiratory syncytial virus (5·4, 95{\%} CrI 4·8–6·3 episodes per 1000 livebirths), followed by Ureaplasma spp (2·4, 1·6–3·2 episodes per 1000 livebirths). Among babies who died, causes were attributed to 46{\%} of pSBI episodes, among which 92{\%} were bacterial. 85 (83{\%}) of 102 blood culture isolates were susceptible to penicillin, ampicillin, gentamicin, or a combination of these drugs. Interpretation: Non-attribution of a cause in a high proportion of patients suggests that a substantial proportion of pSBI episodes might not have been due to infection. The predominance of bacterial causes among babies who died, however, indicates that appropriate prevention measures and management could substantially affect neonatal mortality. Susceptibility of bacterial isolates to first-line antibiotics emphasises the need for prudent and limited use of newer-generation antibiotics. Furthermore, the predominance of atypical bacteria we found and high incidence of respiratory syncytial virus indicated that changes in management strategies for treatment and prevention are needed. Given the burden of disease, prevention of respiratory syncytial virus would have a notable effect on the overall health system and achievement of Sustainable Development Goal. Funding: Bill & Melinda Gates Foundation",
author = "Saha, {Samir K.} and Schrag, {Stephanie J.} and {El Arifeen}, Shams and Mullany, {Luke C.} and {Shahidul Islam}, Mohammad and Nong Shang and Qazi, {Shamim A.} and Zaidi, {Anita K.M.} and Bhutta, {Zulfiqar A.} and Anuradha Bose and Pinaki Panigrahi and Soofi, {Sajid B.} and Connor, {Nicholas E.} and Mitra, {Dipak K.} and Rita Isaac and Winchell, {Jonas M.} and Arvay, {Melissa L.} and Maksuda Islam and Yasir Shafiq and Imran Nisar and Benazir Baloch and Furqan Kabir and Murtaza Ali and Diaz, {Maureen H.} and Radhanath Satpathy and Pritish Nanda and Padhi, {Bijaya K.} and Sailajanandan Parida and Aneeta Hotwani and M. Hasanuzzaman and Sheraz Ahmed and {Belal Hossain}, Mohammad and Shabina Ariff and Imran Ahmed and {Ibne Moin}, {Syed Mamun} and Arif Mahmud and Waller, {Jessica L.} and Iftekhar Rafiqullah and Quaiyum, {Mohammad A.} and Nazma Begum and Veeraraghavan Balaji and Jasmin Halen and {Nawshad Uddin Ahmed}, {A. S.M.} and Weber, {Martin W.} and Hamer, {Davidson H.} and Hibberd, {Patricia L.} and {Sadeq-ur Rahman}, Qazi and Mogan, {Venkat Raghava} and Tanvir Hossain and Lesley McGee and Shalini Anandan and Anran Liu and Kalpana Panigrahi and Abraham, {Asha Mary} and Baqui, {Abdullah H.}",
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TY - JOUR

T1 - Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA)

T2 - an observational cohort study

AU - Saha, Samir K.

AU - Schrag, Stephanie J.

AU - El Arifeen, Shams

AU - Mullany, Luke C.

AU - Shahidul Islam, Mohammad

AU - Shang, Nong

AU - Qazi, Shamim A.

AU - Zaidi, Anita K.M.

AU - Bhutta, Zulfiqar A.

AU - Bose, Anuradha

AU - Panigrahi, Pinaki

AU - Soofi, Sajid B.

AU - Connor, Nicholas E.

AU - Mitra, Dipak K.

AU - Isaac, Rita

AU - Winchell, Jonas M.

AU - Arvay, Melissa L.

AU - Islam, Maksuda

AU - Shafiq, Yasir

AU - Nisar, Imran

AU - Baloch, Benazir

AU - Kabir, Furqan

AU - Ali, Murtaza

AU - Diaz, Maureen H.

AU - Satpathy, Radhanath

AU - Nanda, Pritish

AU - Padhi, Bijaya K.

AU - Parida, Sailajanandan

AU - Hotwani, Aneeta

AU - Hasanuzzaman, M.

AU - Ahmed, Sheraz

AU - Belal Hossain, Mohammad

AU - Ariff, Shabina

AU - Ahmed, Imran

AU - Ibne Moin, Syed Mamun

AU - Mahmud, Arif

AU - Waller, Jessica L.

AU - Rafiqullah, Iftekhar

AU - Quaiyum, Mohammad A.

AU - Begum, Nazma

AU - Balaji, Veeraraghavan

AU - Halen, Jasmin

AU - Nawshad Uddin Ahmed, A. S.M.

AU - Weber, Martin W.

AU - Hamer, Davidson H.

AU - Hibberd, Patricia L.

AU - Sadeq-ur Rahman, Qazi

AU - Mogan, Venkat Raghava

AU - Hossain, Tanvir

AU - McGee, Lesley

AU - Anandan, Shalini

AU - Liu, Anran

AU - Panigrahi, Kalpana

AU - Abraham, Asha Mary

AU - Baqui, Abdullah H.

PY - 2018/7/14

Y1 - 2018/7/14

N2 - Background: More than 500 000 neonatal deaths per year result from possible serious bacterial infections (pSBIs), but the causes are largely unknown. We investigated the incidence of community-acquired infections caused by specific organisms among neonates in south Asia. Methods: From 2011 to 2014, we identified babies through population-based pregnancy surveillance at five sites in Bangladesh, India, and Pakistan. Babies were visited at home by community health workers up to ten times from age 0 to 59 days. Illness meeting the WHO definition of pSBI and randomly selected healthy babies were referred to study physicians. The primary objective was to estimate proportions of specific infectious causes by blood culture and Custom TaqMan Array Cards molecular assay (Thermo Fisher, Bartlesville, OK, USA) of blood and respiratory samples. Findings: 6022 pSBI episodes were identified among 63 114 babies (95·4 per 1000 livebirths). Causes were attributed in 28% of episodes (16% bacterial and 12% viral). Mean incidence of bacterial infections was 13·2 (95% credible interval [CrI] 11·2–15·6) per 1000 livebirths and of viral infections was 10·1 (9·4–11·6) per 1000 livebirths. The leading pathogen was respiratory syncytial virus (5·4, 95% CrI 4·8–6·3 episodes per 1000 livebirths), followed by Ureaplasma spp (2·4, 1·6–3·2 episodes per 1000 livebirths). Among babies who died, causes were attributed to 46% of pSBI episodes, among which 92% were bacterial. 85 (83%) of 102 blood culture isolates were susceptible to penicillin, ampicillin, gentamicin, or a combination of these drugs. Interpretation: Non-attribution of a cause in a high proportion of patients suggests that a substantial proportion of pSBI episodes might not have been due to infection. The predominance of bacterial causes among babies who died, however, indicates that appropriate prevention measures and management could substantially affect neonatal mortality. Susceptibility of bacterial isolates to first-line antibiotics emphasises the need for prudent and limited use of newer-generation antibiotics. Furthermore, the predominance of atypical bacteria we found and high incidence of respiratory syncytial virus indicated that changes in management strategies for treatment and prevention are needed. Given the burden of disease, prevention of respiratory syncytial virus would have a notable effect on the overall health system and achievement of Sustainable Development Goal. Funding: Bill & Melinda Gates Foundation

AB - Background: More than 500 000 neonatal deaths per year result from possible serious bacterial infections (pSBIs), but the causes are largely unknown. We investigated the incidence of community-acquired infections caused by specific organisms among neonates in south Asia. Methods: From 2011 to 2014, we identified babies through population-based pregnancy surveillance at five sites in Bangladesh, India, and Pakistan. Babies were visited at home by community health workers up to ten times from age 0 to 59 days. Illness meeting the WHO definition of pSBI and randomly selected healthy babies were referred to study physicians. The primary objective was to estimate proportions of specific infectious causes by blood culture and Custom TaqMan Array Cards molecular assay (Thermo Fisher, Bartlesville, OK, USA) of blood and respiratory samples. Findings: 6022 pSBI episodes were identified among 63 114 babies (95·4 per 1000 livebirths). Causes were attributed in 28% of episodes (16% bacterial and 12% viral). Mean incidence of bacterial infections was 13·2 (95% credible interval [CrI] 11·2–15·6) per 1000 livebirths and of viral infections was 10·1 (9·4–11·6) per 1000 livebirths. The leading pathogen was respiratory syncytial virus (5·4, 95% CrI 4·8–6·3 episodes per 1000 livebirths), followed by Ureaplasma spp (2·4, 1·6–3·2 episodes per 1000 livebirths). Among babies who died, causes were attributed to 46% of pSBI episodes, among which 92% were bacterial. 85 (83%) of 102 blood culture isolates were susceptible to penicillin, ampicillin, gentamicin, or a combination of these drugs. Interpretation: Non-attribution of a cause in a high proportion of patients suggests that a substantial proportion of pSBI episodes might not have been due to infection. The predominance of bacterial causes among babies who died, however, indicates that appropriate prevention measures and management could substantially affect neonatal mortality. Susceptibility of bacterial isolates to first-line antibiotics emphasises the need for prudent and limited use of newer-generation antibiotics. Furthermore, the predominance of atypical bacteria we found and high incidence of respiratory syncytial virus indicated that changes in management strategies for treatment and prevention are needed. Given the burden of disease, prevention of respiratory syncytial virus would have a notable effect on the overall health system and achievement of Sustainable Development Goal. Funding: Bill & Melinda Gates Foundation

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