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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. 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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  1. Data on burden of pneumonia in the country is limited

  2. Top Killer of Children: Pneumonia Maria Rosario Z. Capeding, M.D. Research Institute for Tropical Medicine

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

  4. 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:

  5. Acute Lower Respiratory Infection/Pneumonia Cases 2009

  6. Active Hospital-based Surveillance Study of IPD and Pneumonia Among Urban Children (2007-2009) Bravo, Santos, Capeding et al Submitted for Publication

  7. Younger Children Bore the Greatest Burden of Pneumonia No. of cases 2008

  8. 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

  9. Outcome of Childhood Pneumonia EVRMC 2008-2011 Lupisan et al Asia-Africa Congress on Emerging and Re-emerging Infections Kobe, Japan January 2012

  10. 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

  11. 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

  12. 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

  13. 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

  14. Mortality Rate by Case Definitions EVRMC Total number of cases = 108

  15. Risk Classification for Pneumonia-Related Mortality

  16. Risk Classification for Pneumonia-Related Mortality

  17. 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

  18. Percent Resistance of S. pneumoniaeJan-Dec 2010 % RESISTANCE CHL=ChloramphenicolPEN=Penicillin SXT=Cotrimoxazole *%R(N) ARSP Report 2010

  19. 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

  20. 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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