Аннотация
Childhood acute community-acquired pneumonia is one of the leading causes of morbidity and mortality in developing countries. In children who have not received prior antibiotic therapy, the main bacterial causes of clinical pneumonia in developing countries are Streptococcus pneumoniae and Haemophilus influenzae type b (Hib), and the main viral cause is respiratory syncytial virus (RSV), but estimates of their relative importance vary in different settings. The only vaccines for the prevention of bacterial pneumonia (excluding vaccines for pertussis and measles) are Hib and pneumococcal conjugate vaccines (PCV). In children with human immunodeficiency virus (HIV) infection, bacterial infection remains a major cause of pneumonia mortality; however, Pneumocystis jirovecii and Mycobacterium tuberculosis are important causes of pneumonia in them. Studies of bacterial aetiology of acute pneumonia in severely malnourished children have implicated Klebsiella pneumoniae, Staphylococcus aureus, S. pneumoniae, Escerichia coli, and H. influenzae, with very few data on the role of respiratory viruses and tuberculosis. Studies of neonatal sepsis suggest that Gram-negative enteric organisms, particularly Klebsiella spp., and Gram-positive organisms, mainly pneumococcus, group b Streptococcus and S. aureus are causes of neonatal pneumonia. Many of the developing countries that ranked high in pneumonia mortality are preparing to introduce new pneumonia vaccines with support from Global Alliance for Vaccine and Immunization (GAVI Alliance), plan for the expansion of community-based case management and have ambitious plans for strengthening health systems. Assurance that these plans are implemented will require funding and continued public attention to pneumonia, which will help contribute to a substantial decline in childhood pneumonia deaths.
Keywords: Children, community-acquired pneumonia, developing countries, epidemiology, aetiology, management, review.
Résumé
La pneumonie aigue acquise dans l’enfance est la principale cause de souffrance et de mortalité dans les pays sous-développés. Les seules vaccins pour la prévention de la pneumonie bactérienne, excluant les vaccins contre la rougeole et varicelle sont les vaccins Hib et and conjugués pneumococales (VCP). Chez les enfants ayant l’infection du virus immunodéficitaire (VIH), l’infection bactérienne reste la cause majeure de la mortalité en pneumonie; Cependant, Pneumocystis jirovecii et Mycobacterium tuberculosis sont les causes important de leur pneumonie. Les études sur l’étiologie bactérienne de la pneumonie aigue chez les enfants sévèrement malnutris ont impliquées les espèces de Klebsiella pneumoniae, Staphylocoque aureus, S. pneumoniae, Escherichia. coli, et H. influenzae, dans leur rôle dans ces cas de virus respiratoires et tuberculose. Les études sur la septicémie néonatale suggèrent que les organismes entériques de grammes négatifs, particulièrement les espèces de Klebsiella, et les grammes positifs, principalement les pneumocoques, groupe de Streptocoque et S. aureus sont les causes de la pneumonie néonatale. Plusieurs des pays sousdéveloppés qui sont classes ayant un taux de mortalité élevé en pneumonie se préparent à introduire de vaccines nouvelles contre la pneumonie de l’alliance GAVI, plan d’expansion des soins communautaires dans l’ambition de renforcer les systèmes de santé. L’assurance que ces plans mise en place nécessitent de financement et l’attention continue du public en pneumonie, qui contribuera à la réduction considérable des décès de pneumonie enfantine.
Correspondence: Professor A. G. Falade, Department of Paediatrics, UCH, Ibadan. Email: afalade33@hotmail.com
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