Treat childhood pneumonia before it gets too late

Pneumonia is the leading single cause of childhood mortality. Childhood pneumonia accounts for 19 per cent deaths in children less than 5 years. Pneumonia kills more children than any other illness, more than measles, malaria and AIDS combined. According to the World Health Organization (WHO) globally 156 million new pneumonia cases are reported every year in the developing world. As many as 8.7 per cent of these cases are severe enough to be life-threatening and require hospitalization. India accounts for the maximum 43 million new cases followed by China (21 million cases) and Pakistan (10 million cases). Pneumonia is estimated to kill 410,000 children in India every year.

Haemophilus influenza and Streptococcus pneumonia are the main causes of bacterial pneumonia and estimated to be the causative organisms for more than 50% of all childhood pneumonias. In addition some diseases, like measles and pertussis (whooping cough) can lead to pneumonia as a complication. It has been shown through various studies that mortality due to pneumonias could be decreased by interventions like prevention of pneumonia through immunization, early diagnosis and optimal case management, exclusive breastfeeding for six months, reducing indoor air pollution, preventive antibiotic treatment in HIV infected children and zinc  supplementation.

In India, pneumonia is responsible for an estimated 410,000 deaths in children under five and a substantial proportion of these deaths are due to pneumococcal pneumonia.  While treatment with antibiotics reduces mortality, lack of access to care and delay in provision of antibiotics, especially among the poor and most vulnerable children result in high case fatality from pneumonia.  Studies have shown that up to 19% of children hospitalized with pneumonia die in India.

Another consideration is the rising resistance to commonly used antibiotics worldwide associated with increasing rates of treatment failures. Hence, prevention of Pneumonia through immunization is an effective way to decrease the incidence and prevent mortality and morbidity in children. Among immunizations, introduction of Haemophilus influenza (Hib) and Pneumococcal vaccines (PCV) and improving immunization coverage of Measles and Pertussis vaccine have been shown to decrease the incidence of Pneumonia in children under 5 years of age.

Hib and Pneumococcal vaccines are safe and cost-effective vaccines and are instrumental in preventing serious and fatal pneumonia in young children under 5 years of age. The WHO recommends prioritizing the use of vaccines, as millions of children, specially the poor, remain at high risk of dying from pneumonia. Introduction of Hib and Pneumococcal conjugate vaccines into the childhood immunization programmes, especially in developing countries, will contribute effectively to achieving the Millennium Development Goal of globally reducing childhood deaths by two-thirds by 2015.

Regarding the cost of Hib and Pneumococcal vaccines, it is recognized that the price in the private market and in industrialized countries is relatively high at present, but past experience, for example with the hepatitis B vaccines, shows that the cost of vaccines do decline drastically when introduced on a large scale. At the projected public sector prices in developing countries, these vaccines are considered highly cost-effective and a worthy allocation even if a country were to self-finance the procurement of the vaccine. The above pattern of ultimate reduction in vaccine cost is also true for the cost of life-saving treatments such as for AIDS, and which have substantially declined over time.

Rahul Kumar Dwivedi – CNS
(Translation: Bobby Ramakant - CNS)