Search

Childhood pneumonia is still a significant clinical and public health problem. India contributes the highest number of deaths due to pneumonia, accounts for about 20% of global mortality among under five children. Various etiologic agents including bacteria, viruses and atypical organism are responsible for childhood pneumonia. Recent studies suggest that viruses are one of the major causes of childhood pneumonia. Among viruses, respiratory syncytial virus has got great attention and several recent studies are reporting it as an important organism for pneumonia. Lack of exclusive breast feeding during first six months, improper timing of start and content of complimentary feeding, anemia, undernutrition, indoor pollution due to tobacco smoking and use of coal and wood for cooking food and lack of vaccinations are important risk factors. X-ray chest is not routinely performed to diagnose pneumonia while use of lung ultrasound is increasing to detect consolidation, pleural effusion, pneumothorax and pulmonary edema (interstitial syndrome). Role of C-reactive protein (CRP) and procalcitonin is similar, to differentiate between viral and bacterial pneumonia, however duration of antibiotics is better guided by procalcitonin. Newer biomarkers like IL-6, presepsin and triggering receptor expressed on myeloid cells 1 are needed to be evaluated for their use in children. Hypoxia is significantly associated with childhood pneumonia. Therefore, use of pulse oximetry should be encouraged for early detection and prompt treatment of hypoxia to prevent adverse outcomes. Among the available tools for risk of mortality assessment in children due to pneumonia, PREPARE score is the best but external validation will be needed. [ABSTRACT FROM AUTHOR]

Available evidence is limited on the association between weather factors and childhood pneumonia, especially in developing countries. This study examined the effects of weather variability on childhood pneumonia after the introduction of pneumococcal conjugate vaccines (PCV) intervention in rural Bangladesh. Data on pneumonia cases and weather variables (temperature and relative humidity) between the 1st January 2012 and the 31st December 2016 were collected from Matlab Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh, and Bangladesh Meteorological Department, respectively. Time series cross-correlation functions were applied to identify the time lags of the effect of each weather factor on pneumonia. Generalized linear regression model with Poisson link was used to quantify the association between weather factors and childhood pneumonia after adjustment of PCV intervention. The annual incidence rate of pneumonia reduced from 5691/100,000 to 2000/100,000 after PCV intervention. Generalized linear regression model suggested that temperature had a negative association with childhood pneumonia (relative risk, 0.985; 95% confidence interval (CI), 0.974–0.997), and PCV intervention was a protective factor with the relative risk estimate of 0.489 (95% CI, 0.435–0.551). However, no substantial association was found with relative humidity. PCV intervention appeared protective against childhood pneumonia, and temperature might be associated with this disease in children. Our findings may help inform public health policy, including the potential of development of early warning systems based on weather factors and PCV for the control and prevention of pneumonia in lower middle-income country like Bangladesh. [ABSTRACT FROM AUTHOR]

Introduction: Childhood pneumonia is a major cause of mortality worldwide while household air pollution (HAP) is a major contributor to childhood pneumonia in low and middle-income countries. This paper presents the prevalence trend of childhood pneumonia in Nepal and assesses its association with household air pollution. Methods: The study analysed data from the 2006, 2011 and 2016 Nepal Demographic Health Surveys (NDHS). It calculated the prevalence of childhood pneumonia and the factors that cause household air pollution. The association of childhood pneumonia and HAP was assessed using univariate and multi-variate analysis. The population attributable fraction (PAF) of indoor pollution for causing pneumonia was calculated using 2016 NDHS data to assess the burden of pneumonia attributable to HAP factors. Results: The prevalence of childhood pneumonia decreased in Nepal between 2006 and 2016 and was higher among households using polluting cooking fuels. There was a higher risk of childhood pneumonia among children who lived in households with no separate kitchens in 2011 [Adjusted risk ratio (ARR) 1.40, 95% CI 1.01–1.97] and in 2016 (ARR 1.93, 95% CI 1.14–3.28). In 2016, the risk of children contracting pneumonia in households using polluting fuels was double (ARR 1.98, 95% CI 1.01–3.92) that of children from households using clean fuels. Based on the 2016 data, the PAF for pneumonia was calculated as 30.9% for not having a separate kitchen room and 39.8% for using polluting cooking fuel. Discussion for Practice: Although the occurrence of childhood pneumonia in Nepal has decreased, the level of its association with HAP remained high. [ABSTRACT FROM AUTHOR]

We analyzed the effects of delivery methods on Chlamydia trachomatis pneumonia in infants. Three hundred forty-four children hospitalized with Chlamydia trachomatis pneumonia were enrolled. They were divided into the vaginal delivery group and the cesarean delivery group. We compared and analyzed their age of onset, peripheral blood white blood cell count, liver enzymes, chlamydia trachomatis titers, and chest radiograph scores. Seventy-eight (22.7%) were delivered by a cesarean, and 266 (77.3%) were delivered vaginally. There were no statistically significant differences between groups when compared by sex and age (P > 0.05). Copy numbers and white blood cell counts in the peripheral blood of children with Chlamydia trachomatis in respiratory secretions of the vaginal delivery group were significantly higher than those of the cesarean delivery group (P < 0.05). The alanine aminotransferase and aspartate aminotransferase levels between groups were not statistically significant. Comparisons of admission chest radiography scores, discharge radiography scores, and score differences showed no statistical differences (P > 0.05).Conclusion: Infants delivered by cesarean comprise approximately one-fifth of those affected. The Chlamydia trachomatis titers and peripheral blood leukocyte counts of the vaginal delivery group were higher than those of the cesarean delivery group. Age of onset, liver enzymes, pulmonary inflammation, and pneumonia absorption were not different between groups. What is Known: • Chlamydia trachomatis is an important pathogen that causes lower respiratory tract infections in infants. • C. trachomatis is primarily transmitted to infants through the infected mother, resulting in Chlamydia trachomatis pneumonia subsequently. What is New: • Vaginal delivery and cesarean delivery can result in Chlamydia trachomatis pneumonia transmission; however, cesarean delivery accounts for ~ 20% of cases. • C. trachomatis volume in the respiratory tract and the number of peripheral blood leukocytes in infants delivered vaginally were higher than those in infants delivered by cesarean. [ABSTRACT FROM AUTHOR]

The burden of community-acquired pneumonia (CAP) in high-income countries is still significant. The introduction of pneumococcal conjugate vaccines (PCV) has reduced the overall need for hospitalization for CAP. However, it is not clear whether children with underlying disease also have benefitted from the PCV immunization programme. Children 0 to <5 years of age hospitalized with CAP and discharged with an ICD-10 code of J13-J18.9 between November 1, 2005, and April 30, 2007 (pre-vaccination period), and November 1, 2010, and April 30, 2012 (post-vaccination period), were eligible for this study. Data on hospitalization and discharge diagnoses were retrieved from the Hospital Registry. In addition, chart review was performed in 50% of the patients. Our result confirmed a decrease in hospitalization rate for CAP in the PCV13 period. Chart review revealed that half of the patients had underlying comorbidity and these children had more severe symptoms and required longer hospital stay. Intensive care was provided to less than 10% of the children and mostly for children with an underlying neurological disease.Conclusions: We show that all children have benefitted from the reduction of CAP hospitalization after introduction of PCV. Our finding emphasizes the importance of children with chronic diseases receiving adequate vaccinations that may protect from lower respiratory diseases. What is known? • Community-acquired pneumonia is a leading infectious cause of hospitalizations and death among children <5 years of age globally • Pneumococcal conjugate vaccine reduces the hospitalizations of all-cause pneumonia What is new? • We show that also children with underlying comorbidities have benefitted from PCV immunization with a reduction of CAP hospitalization • We show that approximately half of all children hospitalized with CAP also have underlying comorbidities. [ABSTRACT FROM AUTHOR]

Illiterate Traditional Birth Attendants (TBAs) were trained to diagnose pneumonia in children using their visual judgement of tachypnoea. This method resulted in 41% wrong diagnosis in the cases with borderline respiratory rate. A simple device, named 'Breath Counter' was designed and TBAs were trained to diagnose pneumonia in children using this instrument. The agreement of TBAs' diagnosis, with diagnosis using WHO criteria of respiratory rate improved from unaided 60% (30/50) to 82% (41/50) by the use of Breath Counter (p less than 0.05). Breath Counter is simple, cheap, effective and can be used even by illiterate persons to diagnose pneumonia in children. It has the potential of becoming a household diagnostic aid. [ABSTRACT FROM AUTHOR]