| Clinical
Features |
Pneumonia, an inflammation of the
lung, is characterized by cough and fast, difficult breathing.
Fever and muscle aches may occur. |
| Etiologic
Agent |
Streptococcus pneumoniae and
Haemophilus influenzae are the leading bacterial pathogens.
Other bacteria (Staphylococcus aureus, and gram-negative
pathogens) most often affect newborns and malnourished children.
Respiratory viruses (RSV, influenza, parainfluenza, and adenovirus)
can be identified in approximately a quarter of children with
pneumonia but are much less likely to cause fatal infection
than are the bacterial pathogens. |
| Incidence |
Approximately 5-10% of all children
<5 years old in developing countries develop pneumonia
each year. |
| Sequelae |
Each year, acute respiratory infections
cause approximately 2 million deaths among children <5
years old and are the leading cause of death in this age group.
About 1% of pneumonia cases result in sequelae (e.g., bronchiectasis),
which increases the risk of recurrent infections. |
| Transmission |
Person-to-person transmission may
occur by direct contact with infectious secretions. Most cases
of pneumonia among children occur sporadically, not in outbreaks. |
| Risk
Groups |
Infants (especially premature or
low birth weight). Nearly 75% of pneumonia deaths occur among
infants under 1 year old. Risk also increases with malnutrition,
malaria, and suppressed immunity. The burden of pneumonia
among children with HIV infection is high. |
| Surveillance |
No standard approach exists for
surveillance in developing countries. Several protocols for
measuring the burden of radiographic pneumonia in children
are being evaluated. |
| Trends |
There has been some decrease in
the number of pneumonia deaths over the last decade due to
more widespread use of antibiotics. It is unknown if the rate
of pneumonia among children in developing countries is changing;
although the increasing prevalence of HIV infection in Africa
has likely led to an increase in bacterial pneumonia there. |
| Challenges |
The impact of the HIV epidemic in
Africa and Asia, spread of antibiotic resistance, use of case-management
algorithm, widespread training of health workers, assuring
antibiotic supply, and identifying strategies to promote global
use of Hib conjugate vaccines. |
| Opportunities |
Conjugate vaccines for H. influenzae
type B (available) and S. pneumoniae (licensed
in the U.S. in 2000) offer the best opportunity to prevent
morbidity and mortality. Increased use of case management
and risk reduction also are important. Use of prophylactic
antibiotics and antiretroviral medicines may decrease the
incidence of HIV-infected children. |
|
December 2003
|
