Pneumonia

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Pneumonia
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Pneumonia leads causes of childhood deaths
Source WHO estimates of the causes of death in
children 2000-03 Bryce Lancet 26 March 2005
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Where do 10 million children die each year
WHO estimates of the causes of death in children
Lancet 2005
4
Source World Health Report 2005
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Percentage of children that die from pneumonia
by country
From Williams et al. Lancet Infect Dis 2002.
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• Age-specific incidence / mortality of pneumonia

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Is pneumonia a problem in emergencies

• Examples of pneumonia deaths
• 63 among Nicaraguan refugees in 1989
• 30 of under-5 deaths in Kabul in 1993
• 80 when combined with malaria and diarrhea among
  Congolese refugees in 1999
• Most data limited to mortality
• Few studies of morbidity

8
Major Causes of Death in emergencies for lt5 Years
Sudan Wad Kowli Camp February 1985
Somalia Gedo Region 7 Camps January 1980
Measles ARI Malaria Diarrhea Other
Source Centers for Disease Control and
Prevention Famine-Affected Refugee and
Displaced Populations Recommendations for Public
Health Issues. MMWR 199241(No. RR-13)8.
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Risk factors for pneumonia

• Low birth weight
• Malnutrition
• Bottle feeding
• Vitamin A deficiency
• HIV infection

• Indoor air pollution
• Household crowding
• Cold exposure

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What causes Pneumonia Viruses

• Respiratory Syncytial Virus
• Adenovirus

• Rhinovirus
• Parainfluenza/Influenza

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What causes Pneumonia Bacteria

• Streptococcus pneumoniae

• Haemophilus influenzae

Source CF. Laine T Sugishita J Rabke-Verani 
M Cavicchia
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• Approaches to Preventing Pneumonia Mortality

• Prompt diagnosis
• WHO algorithm
• Treat cases of pneumonia
• Antibiotics
• Supportive care
• Prevent cases of pneumonia
• Modify risk factors
• Vaccinate

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• Case Definition

Moderate Severe Lower Respiratory Infection in
children 1) Fever 2) Cough 3) Rapid
breathing (more than 50 breaths/minute) A child
has tacypnoea if Respiratory rate gt60/min in
children lt2 months Respiratory rate gt50/min in
children 2-11 months Respiratory rate gt40/min in
children 12-59months
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Control of Lower Respiratory Infections
WHO focuses on the reduction of mortality
requiring Early/adequate diagnosis Correct
case management Hospitalize for danger
signs Access to health care Trained health
staff Simple treatment protocols Immunization
May increase transmission risk for meningitis
MSF book p. 178
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Clinical management of a sick child with cough or
difficult breathing
VERY SEVERE DISEASE
Danger signs
YES
Refer to hospital Give antibiotics
NO
SEVERE PNEUMONIA
Assess for chest indrawing
YES
Refer to hospital Give antibiotics
NO
Assess for fast breathing (RRgt50/40
breaths/minute)
PNEUMONIA
YES
Give antibiotics
NONO PNEUMONIA COUGH OR COLD
Danger signs include cyanosis convulsions
severe malnutrition difficult to wake not able
to drink
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• Recommended Antibiotics for Pneumonia

Antibiotic
Doses/day
Relative cost
Cotrimoxazole
2 PO
Lowest
Amoxicillin
3 PO
Highest
Procaine penicillin
1 IM
Middle
Antibiotic dose needs to be calculated by the
weight of the child
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Results of community case management
interventions on mortality by age
Sazawal and Black. Lancet ID 2003
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• Potential Barriers to Effective Case Management

• Depends on care seeking and access
• recognition of illness
• access to care
• acceptability of care
• Depends on training and supervising health care
  workers
• Depends on availability of antibiotics

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Pneumonia Prevention

• Avoid overcrowding
• Provide alternatives to open indoor fires
• Provide adequate shelter and blankets/heating
• Prevent malnutrition
• Encourage breastfeeding
• Vitamin A supplementation
• Vaccinate
• Reduce Pneumonia
• Reduce secondary bacterial infections

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Existing vaccines to prevent pneumonia

• Routinely used
• Measles
• Pertussis
• Diphtheria
• Haemophilus influenzae type b (In some countries)
• Future
• Pneumococcal
• RSV

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Efficacy of Haemophilus influenzae type b (Hib)
vaccine on pneumonia outcomes
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Tuberculosis in Emergencies

• Not cause of significant mortality
• Post emergency setting affects morbidity
  mortality
• Depending on the epidemiology of the disease
• Need for continuation of treatment for those
  patients who already are on treatment
• Need for effective control program

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Tb Control

• Conditions for implementing TB Program
• Basic health priorities already addressed
• Long term commitment - 1 year from last case
• Stable population - patients complete treatment
• Adequate drug supply
• Knowledge of baseline drug resistance
• Laboratory confirmation
• Appropriate treatment algorithm