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Bacteremia: prevalence among children in Kenya

The New England Journal of Medicine reports in its most recent issue, that community-acquired bacteremia is a major cause of death among children in rural Kenya, highlighting the need for widespread use of existing vaccines for bacterial diseases.

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There are few epidemiologic data on invasive bacterial infections among children in sub-Saharan Africa.

Dr Berkley and colleagues undertook a large study of every acute pediatric admission to a rural district hospital in Kenya in order to examine the prevalence, incidence, types, and outcome of community-acquired bacteremia.

Between August 1998 and July 2002, the researchers cultured blood on admission from a total of 19,339 inpatients.

The investigators calculated the incidence of bacteremia on the basis of the population served by the hospital.

Of a total of 1783 infants who were under 60 days old, the researchers found that 13% had bacteremia, as did 6% of children who were 60 or more days of age.

The research team noted that among infants who were under 60 days old, Escherichia coli and group B streptococci predominated among a broad range of isolates (14% and 11% respectively).

Of all in-hospital deaths, 26 % were in children with community-acquired bacteremia
New England Journal of Medicine

Among infants who were 60 or more days of age, the researchers noted that Streptococcus pneumoniae, nontyphoidal salmonella species, Haemophilus influenzae, and E. coli accounted for more than 70 % of isolates.

The investigators estimated that the minimal annual incidence of community-acquired bacteremia was 1457 cases per 100,000 children among infants under a year old, 1080 among children under 2 years, and 505 among children under 5 years.

The team found that of all in-hospital deaths, 26 % were in children with community-acquired bacteremia.

Of 308 deaths in children with bacteremia, 33% occurred on the day of admission and 71% within two days.

Dr Berkley concluded, "Community-acquired bacteremia is a major cause of death among children at a rural sub-Saharan district hospital, a finding that highlights the need for prevention and for overcoming the political and financial barriers to widespread use of existing vaccines for bacterial diseases."

New England Journal of Medicine; 2005: 352 (1): 39-47
11 January 2005

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