Hospital-based surveillance for radiological pneumonia in children under 5 years of age in Uttar Pradesh and Bihar

Abstract

Pneumonia is responsible for about 1.2 million deaths in children under five years of age, mostly in developing countries, including India. In India. _Streptococcus pneumoniae_ (SP) and _Hemophilus influenzae_ (HI) are the common bacterial etiologic agents of pneumonia, and often cause abnormal chest radiology. Vaccine against HI has already been introduced in India. Pneumococcal conjugate vaccine (PCV)roll out will begin in 2017-18 in a phased manner using Gavi funding. 1. To estimate the annual incidence of radiological pneumonia in children between 2–59 months of age, in pre-specified districts. 2. To document the clinical and demographic characteristics of cases of WHO defined community acquired pneumonia (CAP) with lower chest in-drawing (LCI) and severe CAP, by establishment of hospital-based surveillance network. In a prospective design, surveillance for WHO defined radiological pneumonia in patients hospitalized for CAP is being done in two districts each of Uttar Pradesh and Bihar. For this a pneumonia surveillance network of public and private hospitals has been established. Data is ed from hospital records. One copy of routine chest x-ray is also collected, digitalized and archived electronically. An independent panel of radiologists interprets the x-rays. Five ml of urine of a subset of cases is being stored at -20 degrees Celsius for future antigen testing. In Phase I, procedures were standardized, hospital network established and recruitments initiated from Lucknow district. This was expanded in Phase II, Etawah district, Uttar Pradesh and Patna and Darbhanga districts of Bihar. Apneumonia surveillance network was established, having 120 health facilitiesin Lucknow, 60 in Patna,74in Darbhangaand 17 in Etawah. From 1st January 2015 to 30th April, 2016, 733 CAP cases were enrolled in Lucknow.From 1st January to 30thApril, 2016Patna recruited 227, Darbhanga180 and Etawah 83 cases. Chest x-rays of all cases have been archived for interpretation by the panel of radiologists. Baseline incidence of radiological pneumonia Uttar Pradesh and Bihar will be estimated and follow-up data will enable assessment of the impact of PCV introduction.