Abstract:
Background: In resource-limited settings, acute respiratory infections continue to be the leading
cause of death in young children. We conducted postmortem investigations in children <5 years
hospitalized with a clinical diagnosis of respiratory disease at Kenya's largest referral hospital.
Methods: We collected respiratory and other tissues postmortem to examine pathologic processes
using histology, molecular and immunohistochemistry assays. Nasopharyngeal, trachea, bronchi
and lung specimens were tested using 21-target respiratory pathogen real-time reverse
transcription polymerase chain reaction assays deployed on Taqman Array Cards. Expert panels
reviewed all findings to determine causes of death and associated pathogens.
Results: From 2014 to 2015, we investigated 64 pediatric deaths (median age 7 months).
Pneumonia was determined as cause of death in 70% (42/52) of cases where death was associated
with an infectious disease process. The main etiologies of pneumonia deaths were respiratory
syncytial virus (RSV) (n = 7, 19%), Pneumocystis jirovecii (n = 7, 19%), influenza A (n = 5, 14%)
and Streptococcus pneumoniae (n = 5, 14%)-10% of cases had multi-pathogen involvement.
Among the other 10 deaths associated with a nonpneumonia infectious process, 4 did not have an
etiology assigned, the others were associated with miliary tuberculosis (2), cerebral thrombosis
due to HIV (1), Enterobacteriaceae (1), rotavirus (1), and 1 case of respiratory infection with severe
hypokalemia associated with RSV.
Conclusions: In spite of well-established vaccination programs in Kenya, some deaths were still
vaccine preventable. Accelerated development of RSV monoclonal antibodies and vaccines,
introduction of seasonal influenza vaccination, and maintenance or improved uptake of existing
vaccines can contribute to further reductions in childhood mortality.