Epidemiology and aetiology of community-acquired pneumonia in children : South African Thoracic Society guidelines (part 1)

BACKGROUND. Pneumonia remains a major cause of morbidity and mortality among South African (SA) children. Improved immunisation
\nregimens, strengthening of HIV programmes, better socioeconomic conditions and new preventive strategies have influenced the epidemiology
\nof pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis.
\nOBJECTIVES. To summarise current information on childhood community-acquired pneumonia (CAP) epidemiology and aetiology in
\nchildren as part of the revised South African Thoracic Society guidelines.
\nMETHODS. The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases expert
\nsubgroup on epidemiology and aetiology revised the existing SA guidelines.The subgroup reviewed the published evidence in their area; in
\nthe absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system, and
\nthe relevant section underwent peer review.
\nRESULTS. Respiratory viruses, particularly respiratory syncytial virus, are the key pathogens associated with hospitalisation for radiologically
\nconfirmed pneumonia in HIV-uninfected children. Opportunistic organisms, including Pneumocystis jirovecii, are important pathogens in
\nHIV-infected infants, while non-typable Haemophilus influenzae and Staphylococcus aureus are important in older HIV-infected children.
\nCo-infections with bacteria or other respiratory viruses are common in hospitalised children. Mycobacterium tuberculosis is common in
\nchildren hospitalised with CAP in SA.
\nCONCLUSIONS. Numerous public health measures, including changes in immunisation schedules and expansion of HIV prevention
\nand treatment programmes, have influenced the epidemiology and aetiology of CAP in SA children. These changes have
\nnecessitated a revision of the South African Paediatric CAP guidelines, further sections of which will be published as part of a
\nCME series in SAMJ.