The Study of Chest Infections in Infants Living in a Refugee Camp on the Thai-Burmese Border
The Study of Chest Infections in Infants Living in a Refugee Camp on the Thai-Burmese Border
This study will follow 1000 refugee infants from birth for two years. The aim of the study is
 to better understand why some children develop infections caused by the bacterium
 Streptococcus pneumoniae whilst others merely carry this organism asymptomatically at the
 back of the nose (in the nasopharynx). The investigators will also define which
 micro-organisms cause lower respiratory tract infections (e.g., pneumonia) in this population
 in order to implement appropriate interventions (e.g., vaccines). Infants will be reviewed
 monthly and a nasopharyngeal swab will be taken. A group of 250 mother-infant pairs will be
 studied in greater detail, to improve our understanding of the frequency and outcomes of
 nasopharyngeal carriage of Streptococcus pneumoniae. Monthly nasopharyngeal swabs will be
 collected from mothers and infants. The investigators will measure the infant immune response
 to Streptococcus pneumoniae carriage or disease by taking monthly blood samples. The
 investigators will make an assessment of the protective effect of antibodies acquired from
 the mother during pregnancy by taking blood from the mother and placenta at birth. An
 assessment of pneumococcal carriage in mothers will also be made to determine how frequently
 the bacterium is transmitted between family members. All lower respiratory tract infections
 will be documented, and the causative micro-organisms identified.
This project's central hypothesis is that acute lower respiratory infections (ALRI) are a
 common and significant cause of morbidity and mortality in young children living in Maela
 refugee camp on the Thai-Burmese border, and that this is reflective of the general situation
 in the developing world. Therefore, we aim to define the incidence, aetiology, and outcome of
 acute lower respiratory infections in this population. This will focus on Streptococcus
 pneumoniae and the factors associated with colonisation and invasive disease.

 Additional objectives are to:

 1. Characterise the interaction between bacterial and viral pathogens and disease.

 2. Examine the dynamics of pneumococcal nasopharyngeal carriage, including transmission of
 strains between infants and their mothers.

 3. Determine the effect of the non-pathogenic members of the nasopharyngeal flora on
 colonisation with potential pathogens.

 4. Examine the role of passively transferred maternal pneumococcal antibodies in subsequent
 pneumococcal colonisation and disease in the infant.

 5. Document the development of pneumococcal antibodies in the infants over time and
 correlate these with pneumococcal carriage and infection episodes.

 6. Determine the risk factors associated with respiratory infection.

 7. Characterise the bacteria causing invasive non-respiratory infections.

 8. Conduct surveillance for influenza and in particular avian influenza A (H5N1) infection.
Inclusion Criteria:

 1. Infants born in SMRU antenatal clinic, Maela camp

 2. Written informed consent from the mother