Knowledge gaps on paediatric respiratory infections in Morocco, Northern Africa

BACKGROUND: The burden of acute respiratory infections (ARI) among Moroccan children remains significant. However, scarce information is available regarding trends in its epidemiology and etiology, or regarding its associated prognostic factors. The purpose of this work was to review available data on the burden of ARI among children under five years of age in Morocco. METHODS: A systematic review was conducted for the period 1997-2014 using the PRISMA proposed methodology. Various online databases were screened, in addition to physical libraries of Moroccan medical schools, and official reports of the Moroccan Ministry of Health. Search queries in English and French languages included: Respiratory Tract Infections, pneumonia, epidemiology, etiology, microbiology, mortality and Morocco. The documents were included for analysis when they reported original data on the incidence, distribution, or a clinical description of the diseases or their etiology or described clinical management or national preventive strategies. RESULTS: Thirty-two documents were included in the final analysis. 21 of which had been published. In 2012, ARI caused 13% of paediatric deaths, half of the consultations at health facilities and third of the paediatric admissions. The microorganisms more frequently identified among hospitalized children were Streptococcus pneumoniae (38%) and Haemophilus influenza type b (Hib) (15%). The MOH introduced Hib vaccines into the national immunization program (PNI) in 2007and the 13-valent vaccine against pneumococcus in 2010. The national first line antibiotics recommended for non-severe ambulatory treatment is Amoxicillin. Studies of antibiotic resistance showed from 1998 to 2008 a 22% increase in the rate of penicillin non-susceptibility among Streptococcus pneumoniae isolates. Viral respiratory infections and the role attributed to air pollution in the incidence of ARI have been poorly characterized. CONCLUSIONS: Further efforts should be made towards the development of adequate surveillance programs to better clarify the epidemiology, etiology, antimicrobial susceptibility patterns and the effectiveness of the preventives and curatives strategies in place against paediatric ARIs in Morocco. Additionally, a holistical approach should be used to identify the heath determinants of ARIs among children

Preventive behavior against SARS-CoV-2 infection in adults according to whether or not they live with children. A combined analysis of the nationwide COSMO-SPAIN and ENE-COVID surveys

Introduction: The protection of children is a major driver of behavior among those in charge of their care. We evaluated whether compliance with preventive measures against SARS-CoV-2 infection among adults living with children was different from that of those not living with them, in 2020. Methods: We used the COSMO-SPAIN (N = 867) and the nationally representative ENE-COVID (N = 29,926) surveys to estimate prevalence of compliance (95% confidence interval). Logistic model based standardization methods were applied to estimate standardized prevalence differences (SPrD) to the overall distribution of age, sex, education, history of COVID-19, and residence of other >60 yrs in the household. Results: We observed that adults living with children more frequently avoided bars (SPrDENE-COVID: 4.2%; 95% CI: 2.3-6.1), crowded places (SPrDCOSMO: 8.0%; 95% CI: 0.6-15.1) and did not use public transportation (SPrDENE-COVID: 4.9%; 95% CI: 3.0-6.7). They were also more worried about work and family conciliation (SPrDCOSMO: 12.2%; 95% CI: 4.8-19.5) and about closure of education centers (SPrDCOSMO: 26.5%; 95% CI: 19.4-33.6). Discussion: In general, adults living with children adopted slightly more frequently social distancing measures.IJ was hosted in the National Center of Epidemiology, thanks to a grant of Women for Africa 6th edition, with the contribution of ENDESA. COSMO-SPAIN was funded by Carlos III Health Institute and ENE-COVID was funded by Spanish Ministry of Health, Carlos III Health Institute, and Spanish National Health System.S

Detection of Streptococcus pneumoniae and Haemophilus influenzae type B by real-time PCR from dried blood spot samples among children with pneumonia: a useful approach for developing countries

Correction https://doi.org/10.1371/journal.pone.0147678Background: Dried blood spot (DBS) is a reliable blood collection method for storing samples at room temperature and easily transporting them. We have previously validated a Real-Time PCR for detection of Streptococcus pneumoniae in DBS. The objective of this study was to apply this methodology for the diagnosis of S. pneumoniae and Haemophilus influenzae b (Hib) in DBS samples of children with pneumonia admitted to two hospitals in Mozambique and Morocco. Methods: Ply and wzg genes of S. pneumoniae and bexA gene of Hib, were used as targets of Real-Time PCR. 329 DBS samples of children hospitalized with clinical diagnosis of pneumonia were tested. Results: Real-Time PCR in DBS allowed for a significant increase in microbiological diagnosis of S. pneumoniae and Hib. When performing blood bacterial culture, only ten isolates of S. pneumoniae and none of Hib were detected (3·0% positivity rate, IC95% 1·4-5·5%). Real-Time PCR from DBS samples increased the detection yield by 4x fold, as 30 S. pneumoniae and 11 Hib cases were detected (12·4% positivity rate, IC95% 9·0-16·5%; P<0·001). Conclusion: Real-Time PCR applied in DBS may be a valuable tool for improving diagnosis and surveillance of pneumonia caused by S. pneumoniae or Hib in developing countries

Etiology, epidemiology and clinical characteristics of acute moderate-to-severe diarrhea in children under 5 years of age hospitalized in a referral pediatric hospital in Rabat, Morocco

The objective of the study was to describe the etiology, epidemiology, and clinical characteristics of the principal causes of acute infectious diarrhea requiring hospitalization among children under 5 years of age in Rabat, Morocco. A prospective study was conducted from March 2011 to March 2012, designed to describe the main pathogens causing diarrhea in hospitalized children >2 months and less than 5 years of age. Among the 122 children included in the study, Enteroaggregative E. coli (EAEC) and rotavirus were the main etiologic causes of diarrhea detected. Twelve (9.8%) children were referred to the intensive care unit, while 2, presenting infection by EAEC and EAEC plus a Shigella sonnei respectively, developed a hemolytic uremic syndrome. Additionally, 6 (4.9%) deaths occurred with EAEC being isolated in four of these cases. Diarrheogenic E. coli and rotavirus play a significant role as the two main causes of severe diarrhea while other pathogens such as norovirus or parasites seem to have a minimal contribution. Surveillance and prevention programs to facilitate early recognition and improved management of potentially life-threatening diarrhea-episodes are needed

Streptococcus pneumoniae carriage among healthy and sick pediatric patients before the generalized implementation of the 13-valent pneumococcal vaccine in Morocco from 2010 to 2011

Nasopharyngeal carriage studies provide insights into the local prevalence of circulating pneumococcal serotypes. These data are critical to vaccination monitoring, as they allow for the prediction and assessment of impact. Very little data are available on the carriage of pneumococcal serotypes in Morocco. Here, we describe the prevalence of Streptococcus pneumoniae carriage and serotype distribution among 697 pediatric patients with ages ranging from 2 to 59 months who were admitted to a Moroccan hospital with severe pneumonia, as well as 195 healthy infants and young children who were recruited at a vaccination clinic. Carriage rates were 40.5% (79/195) for healthy children and 22.8% (159/697) for sick children. The most commonly observed circulating serotypes included 6A, 6B and 19F, all of which are included in the current 13-valent anti-pneumococcal conjugate vaccine that was recently introduced in Morocco. Monitoring of circulating serotypes remains necessary after vaccine introduction to assess whether serotype replacement is occurring

Identifying the research, advocacy, policy and implementation needs for the prevention and management of respiratory syncytial virus lower respiratory tract infection in low- and middle-income countries

Introduction: The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures. Methods: A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management. Results: Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision. Conclusion: Seven key actions for improving RSV prevention and management in LMICs are proposed

Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015:a systematic review and modelling study

Background: We have previously estimated that respiratory syncytial virus (RSV) was associated with 22% of all episodes of (severe) acute lower respiratory infection (ALRI) resulting in 55 000 to 199 000 deaths in children younger than 5 years in 2005. In the past 5 years, major research activity on RSV has yielded substantial new data from developing countries. With a considerably expanded dataset from a large international collaboration, we aimed to estimate the global incidence, hospital admission rate, and mortality from RSV-ALRI episodes in young children in 2015. Methods: We estimated the incidence and hospital admission rate of RSV-associated ALRI (RSV-ALRI) in children younger than 5 years stratified by age and World Bank income regions from a systematic review of studies published between Jan 1, 1995, and Dec 31, 2016, and unpublished data from 76 high quality population-based studies. We estimated the RSV-ALRI incidence for 132 developing countries using a risk factor-based model and 2015 population estimates. We estimated the in-hospital RSV-ALRI mortality by combining in-hospital case fatality ratios with hospital admission estimates from hospital-based (published and unpublished) studies. We also estimated overall RSV-ALRI mortality by identifying studies reporting monthly data for ALRI mortality in the community and RSV activity. Findings: We estimated that globally in 2015, 33·1 million (uncertainty range [UR] 21·6–50·3) episodes of RSV-ALRI, resulted in about 3·2 million (2·7–3·8) hospital admissions, and 59 600 (48 000–74 500) in-hospital deaths in children younger than 5 years. In children younger than 6 months, 1·4 million (UR 1·2–1·7) hospital admissions, and 27 300 (UR 20 700–36 200) in-hospital deaths were due to RSV-ALRI. We also estimated that the overall RSV-ALRI mortality could be as high as 118 200 (UR 94 600–149 400). Incidence and mortality varied substantially from year to year in any given population. Interpretation: Globally, RSV is a common cause of childhood ALRI and a major cause of hospital admissions in young children, resulting in a substantial burden on health-care services. About 45% of hospital admissions and in-hospital deaths due to RSV-ALRI occur in children younger than 6 months. An effective maternal RSV vaccine or monoclonal antibody could have a substantial effect on disease burden in this age group

Epidemiology and aetiology of severe respiratory infections among children under five, admitted to the children hospital of Rabat, Morocco

[eng] Pneumonia is one of the major public health problems threats to child survival in large parts of the world. The burden of this disease in terms of morbidity and mortality remains unacceptably high with almost one million children dying every year as a result of pneumonia episode. Over 90% of these pneumonia-associated deaths in young children occur in developing countries and are mainly secondary to bacterial infections. The availability of effective vaccines against bacterial pneumonia, coupled with adequate and efficacious antibiotic treatments, should be sufficient to reduce this burden. In Morocco, a middle income country of North Africa, Pneumonia is the first cause of death of children under five of age. However, few data is available regarding its etiology and epidemiology. The first article of this thesis attempts to comprehensively review what was the available knowledge regarding pediatric pneumonia in Morocco, prior to the initiation of this project. Indeed, scarcity of data often hinders the implementation of measures to prevent and better manage these infections. This review confirms the alarming lack of recent data regarding pediatric pneumonia one of the major killers of children in Morocco. The second article of this thesis is a general overview on the epidemiology, etiology and the clinical presentation of acute respiratory infections in Moroccan children under the age of five years. Through our study, we were able to show a high prevalence of viral infections, with wheezing as the major clinical symptomatology. These findings are similar to what can be found in wealthy countries and markedly differ from the high bacterial burden that can be found in poorer settings, although overall case fatality rates remained unacceptably high in our setting. As a result of afore mentioned high case fatality rates in our series, we decided to investigate the specific risk factors upon admission for a bad prognosis during hospitalization. The results of this analysis are presented in the third article of this thesis. The article concluded that the early identification of factors associated with a poor prognosis could improve management strategies and the survival likelihood of Moroccan children with severe pneumonia. In the fourth article of this thesis, we chose to focus on two highly prevalent and potentially hazardous viruses causing acute respiratory infections in our setting, namely respiratory syncytial virus (RSV) and Human metapneumovirus (hMPV). In this analysis, we compared the epidemiological, clinical and laboratory features of these two infections, and concluded that despite the clinical presentation of those two pathogens was almost indistinguishable, hMPV tented to be highly more severe and significantly associated to a poor outcome. An early recognition of these viruses and good management of the cases is important to guarantee a better outcome. The fifth article of this thesis specifically addresses the use of antibiotics to treat acute respiratory infections in Morocco. By analyzing data on pre-admission antibiotics use, and intra-hospital antibiotics utilization, we discuss whether such valuable drugs are used rationally in the country. This analysis also reflects on whether antibiotic usage may have had or not an impact on antimicrobial resistance rates. The last article of this thesis examines data on the distribution of serotypes among streptococcus pneumoniae isolates from the nasopharynx of healthy children and compares it to those isolated among admitted children with clinical severe pneumonia. These data will be used as a baseline to help assessing the impact of the pneumococcal vaccine and to monitor any potential serotype replacement phenomena. Altogether, this thesis tries to offer a comprehensive snapshot of the situation of pediatric pneumonia in Morocco.[spa] A pesar de los esfuerzos hechos para reducir la carga de mortalidad causada por las infecciones respiratorias agudas, estas enfermedades se mantienen como uno de los principales peligros para la salud infantil en amplias zonas del mundo. Las medidas de control existentes son claramente insuficientes a la hora de reducir globalmente el impacto de infecciones tan comunes en la infancia. De hecho, la carga de estas enfermedades en términos de morbilidad y mortalidad persiste inaceptablemente alta con, anualmente, cerca de un millón de muertes anuales, lo que es lo mismo, una muerte cada 34 segundos. Las infecciones respiratorias agudas, siendo la neumonía su forma más paradigmática, son responsables del 15% de las muertes de niños menores de 5 años en el mundo. Más del 90% de estas infecciones respiratorias agudas se producen en los países en vías de desarrollo, fundamentalmente asociadas a neumonías bacterianas. Mientras que la enfermedad clínica puede afectar a cualquier grupo de edad, la mortalidad por neumonía se ve esencialmente circunscrita a los niños menores de cinco años en los países pobres. La disponibilidad de vacunas efectivas contra las neumonías bacterianas, sumada al uso adecuado de los tratamientos antibióticos, debería ser suficiente para reducir esta carga. Sin embargo, la identificación y tratamiento precoz de los episodios clínicos y al acceso a los centros de salud parecen constituirse como barreras infranqueables en la mayoría de los países pobres. Adicionalmente, la malnutrición y el bajo nivel socio económico imperante en muchos de estos entornos dónde las neumonías son un mayor problema, contribuyen desfavorablemente al mal pronóstico de estas infecciones. El conocimiento de los determinantes locales específicos de la enfermedad respiratoria aguda pediátrica en esos entornos ayudaría a entender o mejor por qué todavía estamos muy lejos de controlar adecuadamente estas infecciones, y profundizar sobre las razones por las cuales siguen causando un impacto tan importante en la salud del niño