Continuing Medical Education

Prevention of community-acquired pneumonia in children: South African Thoracic Society guidelines (part 4)

H J Zar, D P Moore, S Andronikou, A C Argent, T Avenant, C Cohen, R J Green, G Itzikowitz, P Jeena, M P Nicol, A Pillay, G Reubenson, R Masekela, S A Madhi

Abstract


Background. More comprehensive immunisation regimens, strengthening of HIV prevention and management programmes and improved socioeconomic conditions have impacted on the epidemiology of paediatric community-acquired pneumonia (CAP) in South Africa (SA).

Objectives. To summarise effective preventive strategies to reduce the burden of childhood CAP.

Methods. An expert subgroup reviewed existing SA guidelines and new publications focusing on prevention. Published evidence on pneumonia prevention informed the revisions; in the absence of evidence, expert opinion was used. Evidence was graded using the British Thoracic Society (BTS) grading system.

Recommendations. General measures for prevention include minimising exposure to tobacco smoke or air pollution, breastfeeding, optimising nutrition, optimising maternal health from pregnancy onwards, adequate antenatal care and improvement in socioeconomic and living conditions. Prevention of viral transmission, including SARS-CoV-2, can be achieved by hand hygiene, environmental decontamination, use of masks and isolation of infected people. Specific preventive measures include vaccines as contained in the Expanded Programme on Immunisation schedule, isoniazid prophylaxis for tuberculosis, co-trimoxazole prophylaxis for HIV-infected infants and children who are immunosuppressed, and timely diagnosis of HIV, as well as antiretroviral therapy (ART) initiation. HIV-infected children treated with ART from early infancy, and HIV-exposed children, have similar immunogenicity and immune responses to most childhood vaccines as HIV-unexposed infants.

Validation. These recommendations are based on available published evidence supplemented by the consensus opinion of SA paediatric experts, and are consistent with those in published international guidelines.


Authors' affiliations

H J Zar, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town; and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, South Africa

D P Moore, Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

S Andronikou, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa; and Department of Pediatric Radiology, Perelman School of Medicine, University of Pennsylvania, and Children’s Hospital of Philadelphia, PA, USA

A C Argent, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

T Avenant, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa

C Cohen, Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa

R J Green, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa

G Itzikowitz, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

P Jeena, Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

M P Nicol, Division of Medical Microbiology, Department f Pathology, Faculty of Health Sciences, University of Cape Town, South Africa; and Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia

A Pillay, Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

G Reubenson, Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

R Masekela, Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

S A Madhi, South African Medical Research Council Vaccine and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg; and Department of Science and Technology/National Research Foundation: South African Research Chair in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Keywords

Community-acquired pneumonia; South Africa; Children; Guidelines

Cite this article

South African Medical Journal 2020;110(8):741-746. DOI:10.7196/SAMJ.2020.v110i8.15024

Article History

Date submitted: 2020-07-30
Date published: 2020-07-30

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