Pneumococcal conjugate vaccines and hospitalization of children for pneumonia: a time-series analysis, South Africa, 2006­2014

Objective To assess the impact of immunization with pneumococcal conjugate vaccines on all-cause pneumonia hospitalizations among children in Soweto, South Africa. Methods We used data collected at the Chris Hani Baragwanath Hospital in Soweto between 2006 and 2014 ­ i.e. before and after April 2009, when a pneumococcal conjugate vaccine was first included in South Africa's routine immunization programme. Using a Bayesian generalized seasonal autoregressive moving-average model and the data collected in 2006­2008, we estimated the numbers of children that would have been hospitalized for pneumonia between 2010 and 2014 if no pneumococcal conjugate vaccines had been used. These estimates were then compared with the corresponding numbers of hospitalizations observed. Findings Between 2006 and 2014, 26 778 children younger than five years ­ including 3388 known to be infected with human immunodeficiency virus (HIV) ­ were admitted to the study hospital for pneumonia. We estimated that, for the children known to be infected with HIV and for the other children, pneumococcal conjugate vaccines reduced the numbers of hospitalizations for pneumonia in 2014 by 33% (50% credible interval, CrI: 6 to 52) and 39% (50% CrI: 24 to 50), respectively. In the study hospital in 2012­2014, as a result of immunizations with these vaccines, there were an estimated 3100 fewer pneumonia hospitalizations of children younger than five years. Conclusion. In our study hospital, following the introduction of pneumococcal conjugate vaccines into the national immunization programme, there were significant reductions in pneumonia hospitalizations among children

Diagnosis and Management of Community-Acquired Pneumonia in Childhood - South African Thoracic Society Guidelines

Background: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in South African children. The incidence; severity and spectrum of childhood pneumonia have changed owing to the HIV epidemic. Increasing emergence of antimicrobial resistance necessitates a rational approach to the use of antibiotics in pneumonia management. Objective: To develop guidelines for the diagnosis; management and prevention of CAP in South African children. Methods: The Paediatric Assembly of the South African Thoracic Society established five expert subgroups to address: (i) epidemiology and aetiology; (ii) diagnosis; (iii) antibiotic treatment; (iv) supportive therapy; and (v) prevention of CAP. Each subgroup developed a position paper based on the available published evidence; in the absence of evidence; expert opinion was accepted. After peer review and revision; the position papers were synthesised into an overall guideline which was further reviewed and revised. Recommendations: Recommendations based on epidemiological factors include a diagnostic approach; investigations; supportive therapy; appropriate antibiotic treatment and preventive strategies. Specific recommendations for HIV-infected children are provided. Validation: These guidelines are based on the available evidence supplemented by the consensus opinion of South African experts in aediatrics; paediatric pulmonology; radiology; infectious diseases and microbiology. Published international guidelines have also been consulted