Incidence Of Pneumonia In Children Research Articles

Hospital-based surveillance for radiological pneumonia in children under 5 years of age in Uttar Pradesh and Bihar

Abstract Background and rationale Pneumonia is responsible for about 1.4 million deaths in children under five years of age, mostly in developing countries, including India. In India, Streptococcus pneumoniae (SP) and Haemophilus influenzae (HI) are the common bacterial etiologic agents of pneumonia, and often cause abnormal chest radiology. Vaccine against HI has already been introduced in India. Pneumococcal conjugate vaccine (PCV) roll out will begin in 2017–2018 in a phased manner using Gavi funding. Objectives (1) To estimate the annual incidence of radiological pneumonia in children between 2 and 59 months of age, in prespecified districts. (2) To document the clinical and demographic characteristics of cases of WHO-defined community-acquired pneumonia (CAP) with lower chest in-drawing (LCI) and severe CAP, by establishment of hospital-based surveillance network. Study design In a prospective design, surveillance for WHO-defined radiological pneumonia in patients hospitalized for CAP is being done in two districts each of Uttar Pradesh and Bihar. For this, a pneumonia surveillance network of public and private hospitals has been established. Data are abstracted from hospital records. One copy of routine chest X-ray is also collected, digitalized, and archived electronically. An independent panel of radiologists interprets the X-rays. Five milliliters of urine of a subset of cases is being stored at −20 °C for future antigen testing. In Phase I, procedures were standardized, hospital network established, and recruitments initiated from Lucknow district. This was expanded in Phase II to include Etawah district, Uttar Pradesh and Patna and Darbhanga districts of Bihar. Progress A pneumonia surveillance network was established, having 120 health facilities in Lucknow, 60 in Patna, 64 in Darbhanga and 17 in Etawah. From 1st January 2015 to 30th April 2016, 745 CAP cases were enrolled in Lucknow. From 1st January to 30th April 2016 Patna recruited 229, Darbhanga 321 and Etawah 80 cases. Chest X-rays of all cases have been archived for interpretation by the panel of radiologists. Implications Baseline incidence of radiological pneumonia in Uttar Pradesh and Bihar will be estimated and follow-up data will enable assessment of the impact of PCV introduction.

RELATIONSHIP ENVIRONMENTAL FACTORS PHYSICAL AND BEHAVIORAL WITH PNEUMONIA INCIDENCE ON UNDER FIVE YEAR OLD CHILDREN IN THE WORKING AREA OF PUBLIC HEALTH CENTER YOSOMULYO METRO CITY IN 2016

Background : Pneumonia is a health problem that is a major cause of death of children under five years. The cause of pneumonia can be caused by environmental factors in the home that includes a physical home environment and behavioral factors. Based on data from the Health Center Metro Yosomulyo increased cases of pneumonia for three consecutive years. Yosomulyo Health Center is a health center that ranks first pneumonia cases highest in Metro City.The aim of study is analyze relationship between physical housing condition and behavioral with pneumonia incidence Method: This study used a case control study design. The sample in this study were 108 samples with a ratio of 1: 3, which consisted of 27 cases of pneumonia and 81 control cases in the immediate neighborhood. Data analysis was performed using univariate, bivariate and multivariate. Result: The results of the bivariate analysis is known that there are eight independent variables associated with the incidence of pneumonia in children under five is ventilation, humidity, lighting, temperature, mother’s education, presence of family members who smoke, habit of opening window and house cleaning habits. Chi square all <0,05 and multiple logistic regression test custom variable opening the window is the most dominant variable incidence of pneumonia in children under five. Conclusion: Opening the window is a variable habit most dominant related events pneumonia with the toddler in the working area of public health center Yosomulyo Metro City. Keywords: Pneumonia ,Children Under Five, Habit Opens Window DOI: https://doi.org/10.26553/jikm.2016.7.1.6-13

Effect of Climate Factors on the Childhood Pneumonia in Papua New Guinea: A Time-Series Analysis.

This study aimed to assess the association between climate factors and the incidence of childhood pneumonia in Papua New Guinea quantitatively and to evaluate the variability of the effect size according to their geographic properties. The pneumonia incidence in children under five-year and meteorological factors were obtained from six areas, including monthly rainfall and the monthly average daily maximum temperatures during the period from 1997 to 2006 from national health surveillance data. A generalized linear model was applied to measure the effect size of local and regional climate factor. The pooled risk of pneumonia in children per every 10 mm increase of rainfall was 0.24% (95% confidence interval: −0.01%–0.50%), and risk per every 1 °C increase of the monthly mean of the maximum daily temperatures was 4.88% (95% CI: 1.57–8.30). Southern oscillation index and dipole mode index showed an overall negative effect on childhood pneumonia incidence, −0.57% and −4.30%, respectively, and the risk of pneumonia was higher in the dry season than in the rainy season (pooled effect: 12.08%). There was a variability in the relationship between climate factors and pneumonia which is assumed to reflect distribution of the determinants of and vulnerability to pneumonia in the community.

Incidence of childhood pneumonia: facility-based surveillance estimate compared to measured incidence in a South African birth cohort study

BackgroundPneumonia is the leading cause of childhood mortality and a major contributor to childhood morbidity, but accurate measurement of pneumonia incidence is challenging. We compared pneumonia incidence using a facility-based...

82Population-based Incidence of Childhood Pneumonia Associated with Viral Infections in a Tropical Developing Country

82Population-based Incidence of Childhood Pneumonia Associated with Viral Infections in a Tropical Developing Country

Home Air Quality And Case Of Pneumonia In Children Under Five Years Old ((In Community Health Center of South Cimahi and Leuwi Gajah, City of Cimahi)

Pneumonia is the number one deadliest disease in the world with the prevalence of 44%. In Indonesia, pneumonia in to odler is the leading cause of death, after diarrhea, with proportion 15,5%. Pneumonia is a disease caused by a virus and bacteria influenced by physical and chemical contaminants. The purpose of this study is to analyze indoor air quality with the incidence of pneumonia in children under five years old with cross sectional method. The population in this study is the population living in the region of South Cimahi Public Health Center and Leuwi Gajah Public Health Center. The criteria of selection for the region are: region with the highest population, high pneumonia cases (in the red and yellow area), a coal-fired industrial area, and located near the toll Purbaleunyi. The sample of this research are respondents who live in the region of South Cimahi Public Health Center and Leuwi Gajah Public Health Center with inclusion criteria length of stay ≥1 year with a child under five years old. Significant correlation occur between PM10 and PM2,5 (p 0.05) with pneumonia. Dominant factors that cause pneumonia in infants is PM10 (p 0.036) with a value of OR 4.09 after controlled PM2,5 (p 0.142; OR 2.78), the number of bacteria (p 0.004; OR 0.17) and ventilation the house (p 0.395; OR 0.58).

Prospective Surveillance Study of Invasive Pneumococcal Disease Among Urban Children in the Philippines

Worldwide, invasive pneumococcal disease (IPD) causes considerable morbidity and mortality among children, but incidence data in Asia are lacking. This 2-year hospital-based, prospective, surveillance study was conducted at 3 study sites in urban areas of the Philippines to estimate IPD and pneumonia incidence in children and describe the serotype distribution of invasive Streptococcus pneumoniae isolates. Children aged 28 days to <60 months residing within the 3 surveillance areas presenting with possible IPD were enrolled. Initial diagnosis, history of pneumococcal vaccine receipt and previous antimicrobial treatment were recorded. Blood specimens were collected for S. pneumoniae identification and serotyping. Final diagnosis was determined for hospitalized subjects, subjects whose culture yielded S. pneumoniae and subjects with clinically suspected meningitis. A total of 5940 subjects were enrolled, 47 IPD cases identified. IPD site rates were 33.49 per 100,000, 25.38 per 100,000 and 25.85 per 100,000. Chest radiograph-confirmed pneumonia incidence ranged from 633.74 to 1683.59 per 100,000. Highest chest radiograph-confirmed pneumonia incidence occurred in those 28 days to <6 months of age at 2 sites (2166.16 and 3891.94 per 100,000) and those 6-12 months of age at the third site (3847.52 per 100,000). Thirty-five S. pneumoniae isolates were serotyped; most commonly identified were serotypes 1, 2, 5, 6B, 14 and 18F. One serotype 14 isolate was erythromycin resistant. Previous antibiotic therapy was documented in 17-53% of subjects; 2 subjects had received pneumococcal vaccine. At 2 sites, one-third of IPD subjects died. IPD is an important cause of morbidity and mortality among urban children in the Philippines. Our data support the expectation that widespread immunization would decrease IPD disease burden.

The Impact of Local and Oceanic Climate Variability on the Incidence of Childhood Pneumonia in Papua New Guinea

Background: Childhood pneumonia is common in tropical regions, and a number of studies have associated pneumonia risk with climate and other factors. However, the findings have often been contradic...

Respiratory virus surveillance in hospitalised pneumonia patients on the Thailand-Myanmar border

BackgroundPneumonia is a significant cause of morbidity and mortality in the developing world. Viruses contribute significantly to pneumonia burden, although data for low-income and tropical countries are scarce. The aim of this laboratory-enhanced, hospital-based surveillance was to characterise the epidemiology of respiratory virus infections among refugees living on the Thailand-Myanmar border.MethodsMaela camp provides shelter for ~45,000 refugees. Inside the camp, a humanitarian organisation provides free hospital care in a 158-bed inpatient department (IPD). Between 1st April 2009 and 30th September 2011, all patients admitted to the IPD with a clinical diagnosis of pneumonia were invited to participate. Clinical symptoms and signs were recorded and a nasopharyngeal aspirate (NPA) collected. NPAs were tested for adenoviruses, human metapneumovirus (hMPV), influenza A & B, and RSV by PCR.ResultsSeven hundred eight patient episodes (698 patients) diagnosed as pneumonia during the enhanced surveillance period were included in this analysis. The median patient age was 1 year (range: < 1-70), and 90.4% were aged < 5 years. At least one virus was detected in 53.7% (380/708) of episodes. Virus detection was more common in children aged < 5 years old (<1 year: OR 2.0, 95% CI 1.2-3.4, p = 0.01; 1-4 years: OR 1.4, 95% CI 0.8-2.3, p = 0.2). RSV was detected in 176/708 (24.9%); an adenovirus in 133/708 (18.8%); an influenza virus in 68/708 (9.6%); and hMPV in 33/708 (4.7%). Twenty-eight episodes of multiple viral infections were identified, most commonly adenovirus plus another virus. RSV was more likely to be detected in children <5 years (OR 12.3, 95% CI 3.0-50.8, p = 0.001) and influenza viruses in patients ≥5 years (OR 2.8, 95% CI 1.5-5.4, p = 0.002). IPD treatment was documented in 702/708 cases; all but one patient received antimicrobials, most commonly a beta-lactam (amoxicillin/ampicillin +/−gentamicin in 664/701, 94.7%).ConclusionsViral nucleic acid was identified in the nasopharynx in half the patients admitted with clinically diagnosed pneumonia. Development of immunisations targeting common respiratory viruses is likely to reduce the incidence of pneumonia in children living refugee camps and similar settings.

Antibiotics for preventing complications in children with measles.

Measles is the leading killer among vaccine-preventable diseases; it is responsible for an estimated 44% of the 1.7 million vaccine-preventable deaths among children annually. To assess the effects of antibiotics given to children with measles to prevent complications and reduce pneumonia, other morbidities and mortality. We searched CENTRAL 2013, Issue 4, MEDLINE (1966 to May week 4, 2013) and EMBASE (1980 to May 2013). Randomised controlled trials (RCTs) and quasi-RCTs comparing antibiotics with placebo or no treatment, to prevent complications in children with measles. Two review authors independently extracted data and assessed trial quality. Seven trials with 1263 children were included. The methodological quality of most studies was poor. Only two studies were randomized, double-blind trials. There was variation in antibiotics used, their doses, schedule and evaluation of outcome. Pooled study data showedthat the incidence of pneumonia was lower in the treatment group compared to the control group. However, the difference was not statistically significant. Of the 654 children who received antibiotics, 27 (4.1%) developed pneumonia; while out of 609 children in the control group, 59 (9.6%) developed pneumonia (odds ratio (OR) 0.35; 95% confidence interval (0.12 to 1.01). The one trial that showed an increase in the rate of pneumonia with antibiotics was conducted in 1942 and compared oral sulfathiazole with symptomatic treatment.If the results of this trial are removed from the meta-analysis, there is a statistically significant reduction in the incidence of pneumonia in children receiving antibiotics (OR 0.26; 95% CI 0.12 to 0.60). The incidence of other complications was significantly lower in children receiving antibiotics: purulent otitis media (OR 0.34; 95% CI 0.16 to 0.73) and tonsillitis (OR 0.08; 95% CI 0.01 to 0.72). There was no difference in the incidence of conjunctivitis (OR 0.39; 95% CI 0.15 to 1.0), diarrhea (OR 0.53; 95% CI 0.23 to 1.22) or croup (OR 0.16; 95% CI 0.01 to 4.06). No major adverse effects attributable to antibiotics were reported. The studies reviewed were of poor quality and used older antibiotics. This review suggests a beneficial effect of antibiotics in preventing complications such as pneumonia, purulent otitis media and tonsillitis in children with measles. On the basis of this review, it is not possible to recommend definitive guidelines on the type of antibiotic, duration or the day of initiation. There is a need for more evidence from high-quality RCTs to answer these questions.

Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries.

BackgroundThe recent series of reviews conducted within the Global Action Plan for Pneumonia and Diarrhoea (GAPPD) addressed epidemiology of the two deadly diseases at the global and regional level; it also estimated the effectiveness of interventions, barriers to achieving high coverage and the main implications for health policy. The aim of this paper is to provide the estimates of childhood pneumonia at the country level. This should allow national policy–makers and stakeholders to implement proposed policies in the World Health Organization (WHO) and UNICEF member countries.MethodsWe conducted a series of systematic reviews to update previous estimates of the global, regional and national burden of childhood pneumonia incidence, severe morbidity, mortality, risk factors and specific contributions of the most common pathogens: Streptococcus pneumoniae (SP), Haemophilus influenzae type B (Hib), respiratory syncytial virus (RSV) and influenza virus (flu). We distributed the global and regional–level estimates of the number of cases, severe cases and deaths from childhood pneumonia in 2010–2011 by specific countries using an epidemiological model. The model was based on the prevalence of the five main risk factors for childhood pneumonia within countries (malnutrition, low birth weight, non–exclusive breastfeeding in the first four months, solid fuel use and crowding) and risk effect sizes estimated using meta–analysis.FindingsThe incidence of community–acquired childhood pneumonia in low– and middle–income countries (LMIC) in the year 2010, using World Health Organization's definition, was about 0.22 (interquartile range (IQR) 0.11–0.51) episodes per child–year (e/cy), with 11.5% (IQR 8.0–33.0%) of cases progressing to severe episodes. This is a reduction of nearly 25% over the past decade, which is consistent with observed reductions in the prevalence of risk factors for pneumonia throughout LMIC. At the level of pneumonia incidence, RSV is the most common pathogen, present in about 29% of all episodes, followed by influenza (17%). The contribution of different pathogens varies by pneumonia severity strata, with viral etiologies becoming relatively less important and most deaths in 2010 caused by the main bacterial agents – SP (33%) and Hib (16%), accounting for vaccine use against these two pathogens.ConclusionsIn comparison to 2000, the primary epidemiological evidence contributing to the models of childhood pneumonia burden has improved only slightly; all estimates have wide uncertainty bounds. Still, there is evidence of a decreasing trend for all measures of the burden over the period 2000–2010. The estimates of pneumonia incidence, severe morbidity, mortality and etiology, although each derived from different and independent data, are internally consistent – lending credibility to the new set of estimates. Pneumonia continues to be the leading cause of both morbidity and mortality for young children beyond the neonatal period and requires ongoing strategies and progress to reduce the burden further.

The Burden of Childhood Pneumonia in the Developed World

Estimates of the disease burden from childhood pneumonia are available for most developed countries, but they are based mainly on models. Measured country-specific pneumonia burden data are limited to a few nations and differ in case definitions and case ascertainment methods. This review describes pneumonia disease burden in developed countries. We reviewed studies describing childhood pneumonia incidence in North America, Europe, Australia, New Zealand and Japan. Available estimates suggest that each year in developed countries there are up to 2.6 million cases of pneumonia, including 1.5 million hospitalized cases and around 3000 pneumonia deaths (compared with approximately 640 annual deaths from meningitis) in children <5 years of age. Data to inform policy decisions would be improved by information on burden and etiology of severe pneumonia, population-based incidence of ambulatory visits and hospitalizations and prevalence of complications and sequelae.

Impact of the 7-valent pneumococcal conjugate vaccine on the incidence of childhood pneumonia

In September 2006, the 7-valent pneumococcal conjugate vaccine (PCV7) was added to the UK immunization programme. We aimed to evaluate the impact of PCV7 on the incidence of all-cause community-acquired pneumonia (CAP) in children. A prospective survey was undertaken in 2008-2009 at 11 hospitals in North East England of children aged 0-16 years with radiologically confirmed pneumonia. Data were compared to those from a similar survey undertaken in the same hospitals in 2001-2002. A total of 542 children were enrolled, of which 74% were aged <5 years. PCV7 uptake was 90∙7%. The incidence of pneumonia was 11∙8/10,000 [95% confidence interval (CI) 10∙9-12∙9], and the hospitalization rate was 9∙9/10,000 (95% CI 9∙0-10∙9). Compared to 2001, there was a 19% (95% CI 8-29) reduction in the rate of CAP in those aged <5 years, and in those <2 years a 33∙1% (95% CI 20-45) reduction in the incidence of CAP and 38∙1% (95% CI 24-50) reduction in hospitalization rates. However, for those unvaccinated aged ≥5 years, there was no difference in the incidence of CAP and hospitalization rate between both surveys. Since 2001, the overall reduction in incidence was 17∙7% (95% CI 8-26) and for hospitalization 18∙5% (95% CI 8-28). For the <5 years age group there was a lower incidence of CAP in PCV7-vaccinated children (25∙2/10,000, 95% CI 22∙6-28∙2) than in those that were not vaccinated (37∙4/10,000, 95% CI 29∙2-47∙1). In conclusion, PCV7 has reduced both incidence and rate of hospitalization of pneumonia in children, particularly in the <2 years age group.

P171 Impact of heptavalent pneumococcal conjugate vaccine on the incidence of childhood pneumonia seen in hospital in the North East of England

BackgroundCommunity-acquired pneumonia (CAP) is a common childhood infection. In September 2006, heptavalent pneumococcal conjugate vaccine (PCV7) was added into the UK national immunisation programme. Data from this study were compared...

Incidence of childhood pneumonia and serotype and sequence-type distribution inStreptococcus pneumoniaeisolates in Japan

The 7-valent pneumococcal conjugate vaccine (PCV7) is reported to decrease the incidence of community-acquired pneumonia (CAP) in children. To determine the annual incidence of CAP before the introduction of PCV7, we counted the number of children hospitalized with CAP between 2008 and 2009 in Chiba City, Japan. We investigated serotype and multilocus sequence typing (MLST) for Streptococcus pneumoniae isolates in CAP cases. The annual incidence of hospitalized CAP in children aged <5 years was 17.6 episodes/1000 child-years. In 626 episodes, S. pneumoniae was dominant in 14.7% and 0.8% of sputum and blood samples, respectively. The most common serotypes were 6B, 23F and 19F. The coverage rates of PCV7 were 66.7% and 80% in sputum samples and blood samples, respectively. MLST analysis revealed 37 sequence types. Furthermore, 54.1% of the sputum isolates and 40% of the blood isolate were related to international multidrug-resistant clones.

The effect of Haemophilus influenzae type b and pneumococcal conjugate vaccines on childhood pneumonia incidence, severe morbidity and mortality

Background With the aim of populating the Lives Saved Tool (LiST) with parameters of effectiveness of existing interventions, we conducted a systematic review of the literature assessing the effect of Haemophilus influenzae type b (Hib) and pneumococcal (PC) conjugate vaccines on incidence, severe morbidity and mortality from childhood pneumonia.Methods We summarized cluster randomized controlled trials (cRCTs) and case–control studies of Hib conjugate vaccines and RCTs of 9- and 11-valent PC conjugate vaccines conducted in developing countries across outcome measures using standard meta-analysis methods. We used a set of standardized rules developed for the purpose of populating the LiST tool with required parameters to promote comparability across reviews of interventions against the major causes of childhood mortality. The estimates could be adjusted further to account for factors such as PC vaccine serotype content, PC serotype distribution and human immunodeficiency virus prevalence but this was not included as part of the LiST model approach.Results The available evidence from published data points to a summary effect of the Hib conjugate vaccine on clinical pneumonia of 4%, on clinical severe pneumonia of 6% and on radiologically confirmed pneumonia of 18%. Respective effectiveness estimates for PC vaccines (all valent) on clinical pneumonia is 7%, clinical severe pneumonia is 7% and radiologically confirmed pneumonia is 26%.Conclusions The findings indicated that radiologically confirmed pneumonia, as a severe morbidity proxy for mortality, provided better estimates for the LiST model of effect of interventions on mortality reduction than did other outcomes evaluated. The LiST model will use this to estimate the pneumonia mortality reduction which might be observed when scaling up Hib and PC conjugate vaccination in the context of an overall package of child health interventions.

Increasing Incidence of Empyema Complicating Childhood Community‐Acquired Pneumonia in the United States

The incidence of childhood pneumonia decreased following introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in the United States. Recent regional reports suggest an increase in the incidence of childhood pneumonia complicated by empyema. We assessed whether early decreases in pneumonia hospitalization rates were sustained and trends in such hospitalizations complicated by empyema in United States children aged <5 years. Nationwide Inpatient Sample and Census data were used to calculate annual all-cause and pneumococcal pneumonia hospitalization rates for pre-PCV7 (1996-1999) and post-PCV7 years (2001-2007) and to analyze national trends in total and pathogen-specific pneumonia-associated empyema. Among children aged <2 years, all-cause pneumonia hospitalizations decreased 33% (95% confidence interval, 28%-37%) from 1267 cases per 100,000 children in pre-PCV7 years to 852 cases per 100,000 children in post-PCV7 years. Pneumococcal pneumonia hospitalization rates decreased 61% (95% confidence interval, 55%-67%) post-PCV7, compared with pre-PCV7 years. Pneumonia hospitalizations complicated by empyema increased 2.01-fold from 3.5 cases per 100,000 children in 1996-1998 to 7.0 cases per 100,000 children in 2005-2007. Rates of pneumococcal and streptococcal empyema remained stable, whereas rates of staphylococcal and other or unspecified empyema increased 4.08- and 1.89-fold, respectively. Among children aged 2-4 years, all-cause pneumonia rates remained stable, whereas pneumococcal pneumonia decreased by 26% (95% confidence interval, 16-34). Pneumonia complicated by empyema increased 2.81-fold from 3.7 cases per 100,000 children in 1996-1998 to 10.3 cases per 100,000 children in 2005-2007. In this age group, there were 2.17-, 2.80-, 3.76-, and 3.09-fold increases in rates of pneumococcal, streptococcal, staphylococcal, and other or unspecified empyema, respectively. Decreases in childhood pneumonia hospitalization rates following PCV7 introduction were sustained. Although empyema complicated only a small fraction of pneumonia hospitalizations, its prevalence increased substantially. This increase was due to several pathogens and warrants continuing monitoring.

Pneumococcal conjugate vaccines in the prevention of childhood pneumonia

Lower respiratory tract infections are among the most important causes of childhood mortality worldwide, more than 2 million children die due to pneumonia every year. A number of infections caused by the main pathogens related to pneumonia can be prevented through vaccination ( S. pneumoniae, H. influenzae type-b, morbilli, pertussis, influenza). In the last decade, after the introduction of the 7-valent pneumococcal conjugated vaccine (PCV), the epidemiological background of childhood pneumonia has changed. Recently, several studies have been performed to collect data and evidences about the efficacy of PCV against noninvasive pneumococcal diseases (e.g. pneumonia, otitis media). These investigations showed 10-50% decrease of all pneumonia cases, 10-30% decrease of radiologically diagnosed pneumonia, and 50-70% decrease of the incidence of pneumococcal pneumonia in children. The aim of this review was to determine the role of the PCV in the prevention of childhood pneumonia according to the medical literature, and to summarize the efforts of global organizations (WHO, UNICEF, GAVI) in the fight against pneumonia in children.

What imaging should we perform for the diagnosis and management of pulmonary infections?

Keywords Pneumonia.Empyema.Radiography.Ultrasonography.Computedtomography.Image-guidedpercutaneousinterventionDefinition and pathophysiologyPneumonia is an infection of the lower respiratory tract,involving the lung parenchyma. Whereas most pulmonaryinfections in children are viral and of the upper respiratorytract, bacterial pneumonias have a higher morbidity and aremore frequent indications for imaging. It appears that thelung response to an infective antigen is more age-specificthan antigen (i.e. bacteria vs. viral) dependent [1, 2].The complications of pneumonia include parapneumonic(pleural) effusion, empyema, or abscess. Progression of apleural effusion to empyema is through three stages:exudative, fibrinopurulent and organization. These compli-cations may arise when there is an unbalance between thevirulence of the offending organism and the defensemechanisms of the host, which may be compromised byanatomic factors that impede clearance of secretions(congenital malformations such as pulmonary sequestrationand systemic disease such as cystic fibrosis) and/or immunedeficiency conditions.EpidemiologyWorldwide, there are over 150 million cases of pneumoniaannually in children less than 5 years of age [3]. In theUnited States, 20 million hospitalizations occur annually inchildren, but this count includes viral etiologies [3]. In thedeveloped nations, 5–10% of children under the age of5 years will develop pneumonia annually [4]. The incidenceof pneumonia in children is 34 to 40 per 1,000 [5].Complicated pneumonia such as necrotizing pneumoniaand abscess formation increased in incidence over the yearsbetween 1990 and 2005 [6, 7]. Parapneumonic effusionscomplicate pneumonia in 36–56% of cases, resulting in anincidence of 0.4–0.6 per 1,000 [8]. Empyema complicatesan estimated 0.6% of all childhood pneumonias, resulting inan incidence of 3.3 per 100,000 [9]. There has been arecent emergence of community-acquired MethicillinResistant Staphylococcus Aureus (MRSA) pneumonias inchildren, originally thought to be mainly hospital-acquired[10] (Fig. 1).Cost to societyIn the adult population in Europe, the cost to societyresulting from uncomplicated pneumonia (1.1 millioncases annually) is estimated at 8 billion dollars [11].Childhood pneumonias are a frequent cause of doctor visits,antibiotics prescription, loss of work days for parents, andreduction of quality of life [12]. Regarding treatment ofpneumonia with pleural complications, gross total cost isapproximately equal between thoracentesis, pleural drainplacement, or video-assisted thorascopic surgery (VATS),but hospital length of stay is substantially shorter withVATS [8].

High incidence of childhood pneumonia at high altitudes in Pakistan: a longitudinal cohort study

To determine the incidence of pneumonia and severe pneumonia among children living at high altitudes in Pakistan. A longitudinal cohort study was conducted in which 99 female government health workers in Punial and Ishkoman valleys (Ghizer district, Northern Areas of Pakistan) enrolled children at home, conducted home visits every 2 weeks and actively referred sick children to 15 health centres. Health centre staff used Integrated Management of Childhood Illness criteria to screen all sick children aged 2-35 months and identify those with pneumonia or severe pneumonia. Community health workers enrolled 5204 eligible children at home and followed them over a 14-month period, ending on 31 December 2002. Health centre staff identified 1397 cases of pneumonia and 377 of severe pneumonia in enrolled children aged 2-35 months. Among children reported with pneumonia, 28% had multiple episodes. Incidence rates per 100 child-years of observation were 29.9 for pneumonia and 8.1 for severe pneumonia. Factors associated with a high incidence of pneumonia were younger age, male gender and living at high altitude. Pneumonia incidence rates in the Northern Areas of Pakistan are much higher than rates reported at lower altitudes in the country and are similar to those in high-altitude settings in other developing countries. More studies are needed to determine the causes of pneumonia in these high-mountain communities. However, early introduction of the vaccines that are known to prevent pneumonia should be considered.