Severe community-acquired pneumonia in children
Community-acquired pneumonia (CAP) is common among children all over the world, but its incidence and mortality rate are significantly higher in developing countries than in the industrialised world. It is estimated that about 151 million new episodes a year occur among children < 5 years of age in the developing world, with an incidence of 0.29 episodes per child-year and a mortality rate of 1.3–2.6%, or a mortality rate of > 2 million per year. In industrialised countries, the total number of new episodes in the same age group is about 4 million (an incidence of 0.05 episodes per child-year), with an extremely low risk of mortality in otherwise healthy children. In the industrialised world, CAP mortality is a relatively important risk only in subjects with severe chronic underlying diseases.
Global variation in CAP prevalence and mortality results from a number of factors, including malnutrition, crowding, low birthweight, pre-existing HIV infection, the effectiveness of immunisation programmes (especially pneumococcal and Haemophilus influenzae immunisation) and variation in the incidence of measles.
Mortality rates vary considerably within Europe, and are highest in eastern European countries (figure 6).
The reasons for these differences within Europe are not clear, but they may include variations in the number of HIV- infected children and other underlying disease such as TB, as well as the presence of multidrug-resistant bacteria, poor immunisation rates and/or admission to hospital at a late stage of the disease.
In the future, it is important to identify and register the causes of the differences in mortality rates between European countries, and to set up an intervention programme.