Current Issues in The Prevention and Treatment of Pneumonia
Murdoch Childrens Research Institute, Melbourne
University of Melbourne Department of Paediatrics
London School of Hygiene and Tropical Medicine
Pneumonia remains the dominant cause of child mortality and severe morbidity in the world, with most cases occurring in the least developed areas affecting the most impoverished communities. Pneumococcal conjugate vaccines (PCVs), with the potential to prevent 20-40% of severe pneumonia cases, have been available since 2000, with the current generation of 10 or 13 valent vaccines available since 2009 and 2010 respectively. Currently about 40% of the world’s children have access to PCVs, which is very poor for a life-saving vaccine that was developed nearly 30 years ago and has been licensed since 2000.
This is the result of a global duopoly that has maintained high prices, although the Gavi Alliance has made the vaccine available for the world’s poorest countries. The situation is set to improve with India rolling out the vaccine in 2018 and new producers from developing countries entering the market.
However, the problem of serotype replacement has developed in some areas of the world, but not others. New higher valency vaccines may not be the answer. As pneumonia deaths are increasingly concentrated among the poorest and most remote sections of the community, access to appropriate care remains a major obstacle to the prevention of pneumonia deaths. WHO has revised its IMCI recommendations to enable more severe cases to be managed in the community, but new evidence from Kenya has raised doubts about the wisdom of this change, as many potentially fatal cases would have been missed by the new IMCI approach. The answer may lie in the development of more careful, country-specific guidelines and the use of new technologies, particularly pulse oximetry, to identify the children in most need of hospitalization. This is not a simple area as, particularly in Asia, many children who are currently in hospital with pneumonia could be easily managed at home.
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