Today (November 12) is World Pneumonia Day, which remains a major cause of morbidity and mortality worldwide1.
Pneumonia is now commonly referred to as Lower Respiratory Tract Infection (LRTI). A number of different bacteria and viruses can cause LRTI, including pneumococci (Strep pneumoniae), staphylococci and haemophilus species. The most common viruses include influenza, respiratory syncytial virus and of course the current pandemic of COVID19. Six infectious diseases were among the top ten causes of Disability Adjusted Life Years (DALYs) in children younger than 10 years in 2019. The most common infectious diseases was lower respiratory infections (ranked second) followed by diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth)2.
The World Health Organisation (WHO) calculates that LRTI is the largest infectious cause of death in children worldwide, killing 810000 children under the age of 5 in 20171. This group of causes accounts for 15% of all deaths of children under five years old. Children can be protected from pneumonia and its incidence can be reduced with simple interventions, and the bacterial cases can be treated with antibiotics.
The bacteria and viruses causing LRTI are commonly spread by droplet infection from coughing or sneezing. Other routes of infection occur, but are not common. Children who are undernourished are predisposed to infections including pneumonia. Breastmilk contains factors that protect against infection. Infants who are breastfed, particularly exclusive breastfed have lower rates of LRTI and diarrhoeal diseases3-5. Pre-existing illnesses, such as symptomatic HIV infections and measles and on immune-suppressive treatment also increase risk of LRTI.
Several environmental factors also increase a child’s susceptibility to pneumonia including:
- indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung or kerosene)
- living in crowded homes
- parental smoking.
Improving the household environment, improved nutrition (including breastfeeding) and vaccination are strategies for prevention. Pneumococcal conjugate vaccine for children was introduced at the turn of this century, but has not become universal in our region. In 2019 the pneumovax rate in SE Asia, East Asia, Oceania for children was 12%, compared to 80% for measles containing vaccines6. In Australia in 2017, 94% of infants under one year of age were fully vaccinated against pneumococcal disease and rates of hospital admission have plummeted. Pneumovax is also given to adults over 70 years of age, and has reduced hospital admissions in older Australians.
Following the COVID19 pandemic we can expect an increase in LRTI due to the decline in vaccination rates with the general restriction of services. For those who contracted coronavirus infection, persistent lung damage with predispose to pneumonia.
LRTI remains a significant public health challenge in our region.
- World Health Organisation. Pneumonia https://www.who.int/news-room/fact-sheets/detail/pneumonia (accessed 7 Nov 2021). Geneva: WHO; 2021.
- GBD Diseases Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-1222.
- Binns CW, Lee MK. Exclusive breastfeeding for six months: the WHO six months recommendation in the Asia Pacific Region. Asia Pacific journal of clinical nutrition. 2014;23(3):344-350.
- Lee MK, Binns C. Breastfeeding and the Risk of Infant Illness in Asia: A Review. International journal of environmental research and public health. 2019;17(1).
- Raheem RA, Binns CW, Chih HJ. Protective effects of breastfeeding against acute respiratory tract infections and diarrhoea: Findings of a cohort study. Journal of paediatrics and child health. 2017;53(3):271-276.
- GBD Release Vaccine Coverage Collaborators. Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019: a systematic analysis for the Global Burden of Disease Study 2020, Release 1. Lancet. 2021;398(10299):503-521.
Colin Binns, MBBS, PhD
Editor-in-Chief, Asia-Pacific Journal of Public Health
School of Public Health, Curtin University, Perth, Australia
Wah Yun Low, PhD
Managing Editor, Asia-Pacific Journal of Public Health
President, Asia-Pacific Academic Consortium for Public Health
Deputy Executive Director, Asia Europe Institute
University of Malaya, Kuala Lumpur, Malaysia
Victor Hoe Chee Wai, MBBS, PhD
Webmaster, Asia-Pacific Academic Consortium for Public Health
Department of Social and Preventive Medicine, Faculty of Medicine
University of Malaya, Kuala Lumpur, Malaysia
