Kristen Bastug, MD
Nominated From: University of Minnesota
Research Site: Mbarara University
Research Area: Respiratory infections, child health, air pollution
Primary Mentor: Beth K Thielen, MD, PhD
Research Project
The effect of household air pollution on Streptococcus pneumoniae carriage in Ugandan children: a prospective cohort study
Streptococcus pneumoniae is a leading infectious cause of childhood mortality and disproportionately impacts children living in low- and middle-income countries (LMIC). Exposure to S. pneumoniae leads to a range of outcomes including asymptomatic respiratory tract carriage, upper and lower respiratory tract disease (e.g otitis media, sinusitis, pneumonia), and invasive disease (e.g. bacteremia, meningitis)(Figure 1). The carriage state is significant both due to risk of progression to disease states and the potential to facilitate transmission to new hosts. Pneumococcal conjugate vaccines (PCVs) have reduced vaccine-serotype carriage and disease but provide incomplete protection against all circulating serotypes. The risk of pneumococcal carriage and disease may be increased by exposure to household air pollution (HAP) which is commonplace in many East African communities. Biomass fuels used for cooking are associated with negative health effects, but some fuels are “higher polluting” (wood) than others (charcoal). The relationship between cooking fuel type and pneumococcal carriage rate is not well studied and has important implications for clean-air policies, vaccine development, and vaccination strategies in LMIC where the rates of both HAP and pneumococcal disease are high. This study will build upon an existing NIH-funded cohort study in Mbarara, Uganda to measure the rate of S. pneumoniae carriage in children exposed to different types of cooking fuel, generate surveillance data on circulating serotypes, and pilot a personal air pollution exposure assessment in Ugandan children.
Research Significance
Exposure to household air pollution (HAP) is a potentially modifiable risk factor for respiratory tract disease. Financial barriers may limit access to electricity and clean fuel for many families, so studying the impact of exposure to charcoal and wood cooking fuel provides a realistic assessment of the health impacts for fuels used commonly throughout East Africa. Understanding the health effects of exposure to different fuel sources can support clean-air focused health policies. S. pneumoniae is an ideal pathogen for this study due to both a high burden of global childhood mortality and the ability to prevent infection with vaccines and appropriate antibiotic treatment. This study will generate data on serotype prevalence in Ugandan children that can inform vaccine development and implementation strategies in the era of newly released extended-serotype vaccines (PCV-15, PCV-20). Piloting a personal exposure assessment strategy that is feasible for use in pediatric populations and acceptable to caregivers will facilitate the success of subsequent larger studies that examine the impact of HAP on respiratory health in LMIC.
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