The burden of vaccine-preventable invasive bacterial infections and pneumonia in children admitted to hospital in urban Nepal

Dominic F. Kelly*, Stephen Thorson, Mitu Maskey, Sandeep Mahat, Umesh Shrestha, Mainga Hamaluba, Eleri Williams, Sabina Dongol, Anja M. Werno, Howard Portess, Bharat K. Yadav, Neelam Adhikari, Malcolm Guiver, Kurien Thomas, David R. Murdoch, Andrew J. Pollard

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Citations (Scopus)


Background: Protein-polysaccharide vaccines have made a significant impact on the burden of disease caused by encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and have the potential to do so for Salmonella Typhi. Nepal is one of many resource-poor nations with limited information on the epidemiology of childhood infections caused by these pathogens. Methods: Over a 21-month period, we studied children aged ≤12 years admitted to an urban hospital in Nepal with suspected bacteremia, meningitis, or pneumonia. Patan Hospital is a non-profit hospital with the second largest pediatric unit in the Kathmandu Valley. Results: Of 2039 children enrolled in the study, 142 (7.5%) included in the analysis had positive blood cultures. The agents of enteric fever, Salmonella Typhi and Salmonella Paratyphi, accounted for 59/142 (42%) of all bacteremias and were the most frequently cultured pathogens in children ≥1 year of age. S. pneumoniae was isolated in 16% of positive blood cultures and was the most common cause of bacteremia in children <1 year of age. Pneumonia accounted for 51% of admissions in children ≥2 months, with 44% of these children having radiographically defined primary endpoint pneumonia. S. pneumoniae was the most commonly identified pathogen in cases of pneumonia and meningitis. The S. pneumoniae serotype distribution indicated that the 10-valent and 13-valent pneumococcal conjugate vaccines would cover 44% and 47%, respectively, of all S. pneumoniae cultured from blood or cerebrospinal fluid (CSF) isolates and 62% and 67%, respectively, of isolates associated with pneumonia. H. influenzae type b was isolated infrequently from blood or CSF cultures, but is likely to be more important as a cause of pneumonia. Conclusions: The data on the burden of invasive bacterial infections and pneumonia from this study suggest that vaccines in development against Salmonella Typhi and the pneumococcus have the potential to significantly improve the health of children in Nepal.

Original languageEnglish
Pages (from-to)e17-e23
JournalInternational Journal of Infectious Diseases
Issue number1
Publication statusPublished - Jan 2011

Bibliographical note

Funding Information:
The authors of the study would like to acknowledge the contribution of the parents and children in participating in the study; the medical and nursing staff in the emergency department and pediatric wards who helped to identify participants and collect clinical specimens; Ram Babu Shrestha and the staff of the laboratory of Patan Hospital; Dr Mark Zimmerman and Dr Buddha Basnyat who facilitated the organization of the study; Amy Slender of the Oxford Vaccine Group; Dr David Hammer of Canterbury Health Laboratories, Christchurch, New Zealand; the staff of PneumoADIP including Orin Levine, Maria Knoll, Farzana Muhib; the clinical research fellows Rahul Pradhan, Sarah Hanieh, Julie Lewis; and microbiology staff at the Christian Medical College Vellore. The study was funded by PneumoADIP, the University of Oxford Department of Paediatrics, University of Otago Department of Pathology, and an unrestricted grant from Chiron Vaccines. AJP is a Jenner Institute Investigator. DFK is funded by the Oxford Partnership Comprehensive Biomedical Research Centre with funding from the Department of Health's NIHR Biomedical Research Centres funding scheme.


  • Bacterial
  • Children
  • Meningitis
  • Pneumonia
  • Vaccine


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