Data on burden of pneumonia in the country is limited
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Data on burden of pneumonia in the country is limited. Top Killer of Children: Pneumonia. Maria Rosario Z. Capeding, M.D. Research Institute for Tropical Medicine. Pneumonia remains to be a major cause of morbidity and mortality among Filipino children. Pneumonia Morbidity Rate by Region

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Data on burden of pneumonia in the country is limited

Data on burden of pneumonia in the country is limited


Top killer of children pneumonia

Top Killer of Children: Pneumonia

Maria Rosario Z. Capeding, M.D.

Research Institute for Tropical Medicine


Data on burden of pneumonia in the country is limited

Pneumonia remains to be a major cause of morbidity and mortality among Filipino children.


Data on burden of pneumonia in the country is limited

Pneumonia Morbidity Rate by Region

Rate per 100,00 population

CAR: 1750

Region II: 600

Region I: 400

Region III: 250

Region V: 3200

NCR: 450

Region IV-A: 700

Region VIII: 1400

Region IV-B: 350

CARAGA: 450

Region VI: 900

Region X: 600

Region VII: 800

Region XII: 1200

Region IX: 650

Region XI: 1300

2008

ARMM:


Acute lower respiratory infection pneumonia cases

Acute Lower Respiratory Infection/Pneumonia Cases

2009


Active hospital based surveillance study of ipd and pneumonia among urban children 2007 2009

Active Hospital-based Surveillance Study of IPD and Pneumonia Among Urban Children (2007-2009)

Bravo, Santos, Capeding et al

Submitted for Publication


Younger children bore the greatest burden of pneumonia

Younger Children Bore the Greatest Burden of Pneumonia

No. of cases

2008


Risk factors for pneumonia

Risk factors for Pneumonia:

Rudan et al. WHO Bulletin 2008 May 2008, vol 86 no 5; Pneumonia: The Forgotten Killer of Children Unicef/WHO 2006


Outcome of childhood pneumonia evrmc 2008 2011

Outcome of Childhood Pneumonia EVRMC 2008-2011

Lupisan et al Asia-Africa Congress on Emerging and Re-emerging Infections

Kobe, Japan January 2012


Etiology of pneumonia in 5 years old 1984 1986 ritm n 537

Etiology of Pneumonia in <5 Years Old 1984-1986, RITM, N=537

Pre Hib/PCV Era

RSV

37%

Parainfluenza

17%

Adenov 13%

S. pneumo

15%

Mixed

Viral/bacterial

23%

H

influenzae

21%

Others

17%

S

typhi

14%

Lucero, et al. Reviews InfDis 1990


Data on burden of pneumonia in the country is limited

Etiology of Pneumonia in <5 Years Old 1990-1992, RITM, N=332

Pre Hib/PCV Era

Bacterial Pathogens

S. aureus

K. pneumoniae

S. viridans

A. anitratum

Viral Pathogens

Parainfluenza

Influenza A and B

Capeding et al. Etiology of ALRI in Filipino Children under 5 years

Southeast Asian J Trop Med Public Health, Dec. 1994


Data on burden of pneumonia in the country is limited

Etiology of Pneumonia in <5 Years Old 2008-2011, EVRMC N=1582

Hib/PCV Era

S. pneumoniae

H. influenzae

Others

S. aureus

MRSA

S. typhi

RSV 14%

Rhino-A 7%

Rhino-C 6%

hMPV* 3.3%

Others

Influenza A (H1N1)

Influenza A/B

Adenovirus

Parainfluenza

Lupisan et al Asia-Africa Congress on Emerging and Re-emerging Infections

Kobe, Japan January 2012


Determining bacterial etiology in childhood pneumonia is challenging

Determining Bacterial Etiology in Childhood Pneumonia is Challenging

  • Use of conventional bacterial culture considered as gold standard but with low sensitivity

  • Bacteria (S. pneumoniae, H. influenzae) are fastidious organisms

  • High percentage of antibiotic usage prior to hospitalization


Mortality rate by case definitions evrmc

Mortality Rate by Case Definitions EVRMC

Total number of cases = 108


Risk classification for pneumonia related mortality

Risk Classification for Pneumonia-Related Mortality


Risk classification for pneumonia related mortality1

Risk Classification for Pneumonia-Related Mortality


Empiric antibiotic treatment

Empiric Antibiotic Treatment

  • PCAP A or B without previous antibiotic

    • Oral amoxicillin, drug of choice

  • PCAP C without previous antibiotic and complete Hib vaccination.

    • Penicillin G, drug of choice

  • PCAP C with incomplete Hib vaccination

    • Ampicillin IV

  • PCAP D

    • Refer to Specialist

  • CPG, In the Evaluation and Management of Pediatric Community Acquired Pneumonia


    Percent resistance of s pneumoniae jan dec 2010

    Percent Resistance of S. pneumoniaeJan-Dec 2010

    % RESISTANCE

    CHL=ChloramphenicolPEN=Penicillin SXT=Cotrimoxazole

    *%R(N)

    ARSP Report 2010


    Clinical management of viral etiology

    Clinical Management of Viral Etiology

    • In laboratory confirmed influenza A or B virus infection.

      • Influenza A: amantadine for 3-5 days, an option to discontinue within 24-48 hours after resolution of symptoms

      • Influenza A or B: oseltamivir for 5 days

  • Both drugs should be administered within 48 hours of onset of symptoms, ineffective against respiratory viruses other than influenza, not recommended for children below 1 year old

  • CPG, In the Evaluation and Management of Pediatric Community Acquired Pneumonia


    Burden of pneumonia over the past decades

    Burden of Pneumonia Over the Past Decades

    • Pneumonia is the most common presentation of IPD in children.

    • Most commonly affects the very young

    • S. pneumoniae, H. influenzaeand RSV consistently are the most frequently detected pathogens

    • Pneumonia is the top killer of Filipino children <5 years old, accounts for 34% of deaths

    the

    90’s


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