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

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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

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

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

No. of cases

2008


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

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

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


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


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

  • 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

Total number of cases = 108


Risk Classification for Pneumonia-Related Mortality


Risk Classification for Pneumonia-Related Mortality


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. pneumoniaeJan-Dec 2010

    % RESISTANCE

    CHL=ChloramphenicolPEN=Penicillin SXT=Cotrimoxazole

    *%R(N)

    ARSP Report 2010


    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

    • 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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