摘要
Background:Estimates of the burden of invasive bacterial disease in sub-Saharan Africa have previously relied on selected groups of patients,such as inpatients;they are,therefore,probably underestimated,potentially hampering vaccine implementation.Our aim was to assess the incidence of bacteraemia in all children presenting to a hospital in Kenya,irrespective of clinical presentation or decision to admit.Methods:We did a community-based observational study for which we cultured blood from 1093 children who visited a Kenyan hospital outpatient department.We estimated bacteraemia incidence with a Demographic Surveillance System,and investigated the clinical significance of bacteraemia and the capacity of clinical signs to identify cases.Results:The yearly incidence of bacteraemia per 100 000 children aged younger than 2 years and younger than 5 years was 2440(95%CI 1307-3573)and 1192(692-1693),respectively.Incidence of pneumococcal bacteraemia was 597(416-778)per 100 000 person-years of observation in children younger than age 5 years.Three-quarters of episodes had a clinical focus or required admission,or both;one in six was fatal.After exclusion of children with occult bacteraemia,the incidence of clinically significant bacteraemia per 100 000 children younger than age 2 years or 5 years fell to 1741(790-2692)and 909(475-1343),respectively,and the yearly incidence of clinically significant pneumococcal bacteraemia was 436(132-739)per 100 000 children younger than 5 years old.Clinical signs identified bacteraemia poorly.Interpretation:Clinically significant bacteraemia in children in Kilifi is twice as common,and pneumococcal bacteraemia four times as common,as previously estimated.Our data support the introduction of pneumococcal vaccine in sub-Saharan Africa.
Background: Estimates of the burden of invasive bacterial disease in sub-Saharan Africa have previously relied on selected groups of patients, such as inpatients; they are, therefore, probably underestimated, potentially hampering vaccine implementation. Our aim was to assess the incidence of bacteraemia in all children presenting to a hospital in Kenya, irrespective of clinical presentation or decision to admit. Methods: We did a community-based observational study for which we cultured blood from 1093 children who visited a Kenyan hospital outpatient department. We estimated bacteraemia incidence with a Demographic Surveillance System, and investigated the clinical significance of bacteraemia and the capacity of clinical signs to identify cases. Results: The yearly incidence of bacteraemia per 100 000 children aged younger than 2 years and younger than 5 years was 2440 (95% CI 1307 -3573) and 1192 (692-1693), respectively. Incidence of pneumococcal bacteraemia was 597 (416-778) per 100 000 person-years of observation in children younger than age 5 years. Three-quarters of episodes had a clinical focus or required admission, or both; one in six was fatal. After exclusion of children with occult bacteraemia, the incidence of clinically significant bacteraemia per 100 000 children younger than age 2 years or 5 years fell to 1741 (790-2692) and 909 (475-1343), respectively, and the yearly incidence of clinically significant pneumococcal bacteraemia was 436 (132-739) per 100 000 children younger than 5 years old.