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Population-based Incidence of Childhood Pneumonia Associated With Viral Infections in Bangladesh

Havers, Fiona P., MD*; Fry, Alicia M., MD*; Goswami, Doli, MBBS; Nahar, Kamrun, MBBS; Sharmin, Amina Tahia, MBBS; Rahman, Mustafizur, PhD; Brooks, W. Abdullah, MD

The Pediatric Infectious Disease Journal: April 2019 - Volume 38 - Issue 4 - p 344–350
doi: 10.1097/INF.0000000000002155
Original Studies

Background: The contribution of respiratory viruses to childhood pneumonia in tropical low- and middle-income countries is poorly understood. We used population-based respiratory illness surveillance in children 5 years of age or younger in Dhaka, Bangladesh, to characterize these illnesses.

Methods: We conducted weekly home visits to children who were referred to clinic for fever or respiratory symptoms. Standardized clinical data were collected. Nasopharyngeal washes were collected for one fifth of children diagnosed with a febrile or respiratory syndrome, with virus isolation testing for influenza and reverse transcription polymerase chain reaction testing for other viruses. Pneumonia was defined as age-specific tachypnea and crepitations on chest auscultation by study physicians.

Results: From April 2004 to February 2008, 17,584 children were followed for 17,644 child-years; 6335 children had 12,499 clinic visits with eligible illnesses, including 6345 pneumonia episodes (incidence of 36 episodes/100 child-years). Annual incidence of pneumonia/100 child-years ranged from 88.3 for children 0–6 months of age to 13.1 for those 36–60 months of age. Of 1248 pneumonia visits with laboratory testing, 803 (64%) had detection of viral pathogens, including 274 respiratory syncytial virus (22% of pneumonia visits with laboratory testing; incidence 7.9/100 child-years), 244 adenovirus (19%; 7.0/100 child-years), 198 human metapneumovirus (16%; 5.7/100 child-years), 174 parainfluenza (14.0%; 5.0/100 child-years), and 81 influenza (6.5%; 2.3/100 child years).

Conclusions: Viral pathogens contribute to a majority of childhood pneumonia episodes in Bangladesh, a setting with high pneumonia rates, especially in children 2 years of age or younger. Developing effective prevention strategies targeting these children is a high priority. Given less sensitive laboratory method used for influenza detection, influenza rates may be underestimated.

From the *Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia

International Center for Diarrheal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Accepted for publication May 25, 2018.

Supported by the US Centers for Disease Control and Prevention National Center for Immunization and Respiratory Diseases Cooperative Agreement with the International Centre for Diarrheal Disease Research, Bangladesh (ICDDRB) and by grants from the US Department of Health and Human Services, the PneumoADIP Project at the Johns Hopkins Bloomberg School of Public Health, the Thrasher Research Fund, and the Bill and Melinda Gates Foundation and core donors to ICDDR,B.

The authors have no conflicts of interest to disclose.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Fiona P. Havers, MD, MHS, Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-32, Atlanta, GA 30333. E-mail:

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