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Paediatric Research Unit

Introduction

The Paediatric Research Unit under the Department of Paediatrics of Patan hospital was founded in 2005 and has been working in close collaboration with University of Oxford, Ministry of Health & Population (MOHP) and Child Health Division (CHD).

The main aim of the research unit is to study the important aspects of child health especially vaccine preventable diseases and produce robust information and generate local data for Nepal.

Over the past 15 years, the unit has conducted several collaborative researches with international collaborators (University of Oxford, WHO, University of Otago, John Hopkins, IVAC, Gavi, Nepal Paediatric Society), presented at different national and international conferences and published many scientific papers in national and international journals.

Activities

The Paediatric Research Unit started with the surveillance of the Paediatric invasive bacterial diseases in Patan hospital, which is still ongoing with support from WHO and generating information on the infectious diseases, its prevalence and distribution.

Studies looking at the nasopharyngeal carriage of Hemophilus Influenzae B (Hib), as an indirect marker of the Hib disease burden among Nepali children, were conducted before the Hib vaccine was introduced in the country; and the information was shared with the MOHP and CHD.

Similarly the information on Pnemococcal disease burden and serotype distribution among the Nepali children and the effective pneumococcal vaccine schedule were collected through different studies/ researches conducted by the unit. All these information were valuable for the country’s policy decision on vaccine introduction and choice of vaccine and the schedule.

Over the years the unit has evolved, with the start of the PneumoNepal Project in 2014, which is supported by Gavi, the Vaccine Alliance and made possible by additional partnerships with various national and international collaborators. The project started with the study of nasopharyngeal carriage of pneumococcus in healthy children and children with pneumonia, and comparing the carriage data pre and post Pneomococcal vaccine introduction. After the introduction of 10-valent pneumococcal conjugate vaccine in 2015 into the Nepal’s infant immunization schedule with a unique 2+1 schedule having second priming dose at 10 weeks, the unit conducted a study to evaluate the Nepal schedule. The study demonstrated its equal effectiveness to the WHO’s standard PCV schedule and this was an important information to the ministry for affirmation of its decision. The PneumoNepal study is also evaluating the programmatic and economic impact of the PCV10 program in Nepal.

The Paediatric Research Unit has also conducted various other studies including pneumococcal transcriptomics and RSV.

Future plan

The plan is to expand this work to include other emerging Paediatric illnesses, Nepal’s infant immunization schedule and other public health priorities in Nepal.

World Pneumonia day 2021

On the occasion of World Pneumonia day, the work of the PAHS Paediatric Research Unit was featured in the Gavi website, John Hopkins website and Oxford vaccine group page.Here are the links:

https://mailchi.mp/d8e0b3221b3e/world-immunization-week-webinar-series-10538677?e=2033ab8397

https://www.jhsph.edu/ivac/2021/10/04/frontline-investigators-shrijana/

https://twitter.com/OxfordVacGroup/status/1458702306401206274

https://www.gavi.org/vaccineswork/sickness-and-survival-pre-covid-19-nepal

Publications

  1. Hospital based surveillance of invasive pneumococcal disease aog young children in urban Nepal Clin Infect Dis 2009;48 Suppl 2:S114-22.
  2. Kinetics of the natural, humoral immune response to Salmonella enterica serovar Typhi in Kathmandu, Nepal. Clin Vaccine Immunol 2009; 16(10):1413-9.
  3. Standardizing surveillance of pneumococcal disease: (2009) Clinical Infectious Diseases, 48 (SUPPL. 2), pp. S37-S48. http://www.scopus.com/inward/record.url?eid=2-s2.0-61849137707&partnerID=40&md5=6d68f9be7f083cf3637acb018eff7c72
  4. High-throughput bacterial SNP typing identifies distinct clusters of Salmonella Typhi causing typhoid in Nepalese children. BMC Infect Dis 2010; 10:144.
  5. The burden of vaccine-preventable invasive bacterial infections and pneumonia in children admitted to hospital in urban Nepal. Int J Infect Dis 2011; 15(1):e17-23.
  6. Haemophilusinfluenzae Type b Carriage and Novel Bacterial Population Structure among Children in Urban Kathmandu, Nepal. J ClinMicrobiol2011; 49 (4): 1323-30
  7. Rotavirus and its Genotype Distribution among Children Less than Three Years Presenting with Acute Watery Diarrhoea to a General Hospital in Urban Nepal. J Nep PaedtrSoc2011; 31(2): 110-15
  8. Clinical profile of invasive pneumococcal disease in Patan hospital, Nepal: (2011) Kathmandu University Medical Journal, 9 (33), pp. 45-49. http://www.scopus.com/inward/record.url?eid=2-s2.0-84862251027&partnerID=40&md5=65c63efb4ace0c819989392ec49fea95
  9. Evaluation of Haemophilus influenzae Type b Vaccine for Routine Immunization in Nepali Infants. Pediatr Infect Dis J 2012; 31(4): e66–72
  10. Bloodstream Infection among Children Presenting to a General Hospital Outpatient Clinic in Urban Nepal. PLoS One 2012; 7(10): e47531.
  11. Prevalence and genetic analysis of phenotypically Vi- negative salmonella typhi isolates in children from Kathmandu, Nepal: (2013) Journal of Tropical Pediatrics, 59 (4), pp. 317-320. http://www.scopus.com/inward/record.url?eid=2-s2.0-84881524116&partnerID=40&md5=9c2df41373fb1fca9711a3d9fc0ea4a5
  12. Streptococcus pneumoniae Carriage Prevalence in Nepal: Evaluation of a Method for Delayed Transport of Samples from Remote Regions and Implications for Vaccine Implementation: PLoS ONE 9(6): e98739. doi:10.1371/journal.pone.0098739
  13. The seroepidemiology of Haemophilus influenzae type B prior to introduction of immunization programme in Kathmandu, Nepal:(2014) PLoS ONE, 9 (1), art. no. e85055,http://www.scopus.com/inward/record.url?eid=2-s2.0-84899801321&partnerID=40&md5=f1ac0d3de60eabc1d48e821a191f0891
  14. Genome Sequencing of an Extended Series of NDM-Producing Klebsiella pneumoniae Isolates from Neonatal Infections in a Nepali Hospital Characterizes the Extent of Community- versus Hospital-Associated Transmission in an Endemic Setting.(2014) Antimicrobial and Agents Chemotherapy. 2014 Dec; 58(12): 7347–7357. http://dx.doi.org/10.1128/AAC.03900-14
  15. Dynamics of MDR Enterobacter cloacae outbreaks in a neonatal unit in Nepal: insights using wider sampling frames and next-generation sequencing Journal of Antimicrobial Chemotherapy 2015; doi: 10.1093/jac/dku521
  16.  Multi-Serotype Pneumococcal Nasopharyngeal Carriage Prevalence in Vaccine Naïve Nepalese Children, Assessed Using Molecular Serotyping. (2015) PLoSONE10(2): e0114286.doi: 10.1371/journal.pone.0114286 http://dx.plos.org/10.1371/journal.pone.0114286
  17. Comparison of two-dose priming plus 9-month booster with a standard three-dose priming schedule for a ten-valent pneumococcal conjugate vaccine in Nepalese infants: a randomised, controlled, open-label, non-inferiority trial:(2015) The Lancet Infectious Diseases , Volume 15 , Issue 4 , 405 – 414http://dx.doi.org/10.1016/S1473-3099(15)70007-1
  18.  Laboratory and molecular surveillance of paediatrictyphoidal Salmonella in Nepal: Antimicrobial resistance and implications for vaccine policy. PLoSNegl Trop Dis 12(4): e0006408. https://doi.org/10.1371/journal.
  19. Serotype-Specific Correlates of Protection for Pneumococcal Carriage: An Analysis of Immunity in 19 Countries. Clin Infect Dis. 2018 Mar 5;66(6):913-920. doi: 10.1093/cid/cix895.
  20. Use of weighted multivariate estimates in trials of multi-serotype vaccines to simplify interpretation of treatment differences. PLoS One. 2018 Apr 27;13(4): e0196200.doi: 10.1371/journal.pone.0196200. e Collection 2018.
  21. Comparison of twoschedules of two-dose priming with the ten-valent pneumococcal conjugate vaccine in Nepalese children: an open-label, randomised non-inferiority controlled trial. Lancet Infect Dis 2019; published online Jan 8. http://dx.doi.org/10.1016/S1473-3099(18)30568-1.
  22. Assessment of an Antibody-in-Lymphocyte Supernatant Assay for the Etiological Diagnosis of Pneumococcal Pneumonia in Children. Frontiers in Cellular and Infection Microbiology, 17 January 2020 | https://doi.org/10.3389/fcimb.2019.00459

Useful Links for further information

Home

https://www.jhsph.edu/ivac/2021/10/04/frontline-investigators-shrijana/

https://www.gavi.org/fighting-pneumonia-in-nepal-surveillance

https://www.gavi.org/news/media-room/fighting-pneumonia-nepal-making-numbers-count

https://stoppneumonia.org/making-numbers-count-fighting-pneumonia-in-nepal/

https://www.jhsph.edu/ivac/2020/06/22/commentary-the-pneumococcal-vaccine-is-bolstering-child-health-in-nepal/

https://www.youtube.com/watch?v=niyMpD_aGVUhttps://www.jhsph.edu/ivac/2020/06/22/commentary-the-pneumococcal-vaccine-is-bolstering-child-health-in-nepal/