Pneumonia
Key facts
·Pneumonia is the leading infectious cause of death in children worldwide, accounting for 15% of all deaths of children under 5 years old.
·Pneumonia killed an estimated 935 000 children under the age of five in 2013.
·Pneumonia can be caused by viruses, bacteria or fungi.
·Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors.
·Pneumonia caused by bacteria can be treated with antibiotics, but only one third of children with pneumonia receive the antibiotics they need.
Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.
Pneumonia is the single largest infectious cause of death in children worldwide. Pneumonia killed an estimated 935 000 children under the age of five in 2013, accounting for 15% of all deaths of children under five years old. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. Children can be protected from pneumonia, it can be prevented with simple interventions, and treated with low-cost, low-tech medication and care.
Causes
Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are:
·Streptococcus pneumoniae– the most common cause of bacterial pneumonia in children;
·Haemophilus influenzaetype b (Hib) – the second most common cause of bacterial pneumonia;
·respiratory syncytial virus is the most common viral cause of pneumonia;
·in infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.
Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this is of critical importance for treatment and prevention.
Presenting features
The presenting features of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia. In children under 5 years of age, who have cough and/or difficult breathing, with or without fever, pneumonia is diagnosed by the presence of either fast breathing or lower chest wall indrawing where their chest moves in or retracts during inhalation (in a healthy person, the chest expands during inhalation). Wheezing is more common in viral infections.
Very severely ill infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.
Risk factors
While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child's immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed.
Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia.
The following environmental factors also increase a child's susceptibility to pneumonia:
·indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)
·living in crowded homes
·parental smoking.
Treatment
Pneumonia should be treated with antibiotics. The antibiotic of choice is amoxicillin dispersable tablets. Most cases of pneumonia require oral antibiotics, which are often prescribed at a health centre. These cases can also be diagnosed and treated with inexpensive oral antibiotics at the community level by trained community health workers. Hospitalization is recommended only for severe cases of pneumonia, and for all cases of pneumonia in infants younger than 2 months of age.
Prevention
Preventing pneumonia in children is an essential component of a strategy to reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.
Adequate nutrition is key to improving children's natural defences, starting with exclusive breastfeeding for the first 6 months of life. In addition to being effective in preventing pneumonia, it also helps to reduce the length of the illness if a child does become ill.
Addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.
In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of contracting pneumonia.
Economic costs
The cost of antibiotic treatment for all children with pneumonia in 66 of the countdown to 2015 countries for maternal, newborn and child survival is estimated at around US$ 109 million per year. The price includes the antibiotics and diagnostics for pneumonia management.
WHO response
The WHO and UNICEF integrated Global action plan for pneumonia and diarrhoea (GAPPD) aims to accelerate pneumonia control with a combination of interventions to protect, prevent, and treat pneumonia in children with actions to:
·protectchildren from pneumonia including promoting exclusive breastfeeding and adequate complementary feeding;
·preventpneumonia with vaccinations, hand washing with soap, reducing household air pollution, HIV prevention and cotrimoxazole prophylaxis for HIV-infected and exposed children;
·treatpneumonia focusing on making sure that every sick child has access to the right kind of care -- either from a community-based health worker, or in a health facility if the disease is severe -- and can get the antibiotics and oxygen they need to get well;
A number of countries including Bangladesh, India, Uganda and Zambia have developed district, state and national plans to intensify actions for the control of pneumonia and diarrhoea.
肺炎
主要事實
2013年肺炎是全球兒童死亡的主要感染原因，佔5歲以下兒童死亡人數的15％，。
肺炎侵害估計五歲以下的兒童93萬5仟名
肺炎可以由病毒，細菌或真菌引起。
肺炎是可預防，可增強免疫力，給予充分的營養以及加強週遭環境清潔。
由細菌引起的肺炎可用抗生素治療，但只有三分之一的肺炎患兒需要抗生素的治療。
肺炎是急性呼吸道感染，影響肺的形式。肺是由小囊稱為肺泡，當一個健康的人呼吸時會充滿空氣，如果當一個人有肺炎，肺泡充滿了膿和液體，使呼吸產生疼痛並限制吸氧量。
肺炎是世界衛生組織兒童死亡的最大原因。在2013年肺炎殺害估計五歲以下的兒童93萬5仟名，佔兒童死亡人數的15％。肺炎影響的兒童和家庭比比皆是，但最常見的是在南亞和撒哈拉以南非洲地區。它可以用簡單的預防措施進行預防，並用低成本，低含量的藥物和預訪保健治療。孩子們就可以得到保護，免受肺炎感染
原因
肺炎是由許多感染因子，包括病毒，細菌和真菌引起的。最常見的是：
·肺炎鏈球菌-兒童細菌性肺炎的最常見的原因;
·流感嗜血桿菌b型桿菌（Hib） -細菌性肺炎的第二個最常見的原因;
·呼吸道合胞病毒是肺炎的最常見的病毒引起;
·在感染愛滋病毒的嬰兒，肺囊蟲是肺炎最常見的原因，負責至少四分之一的肺炎死亡的愛滋病毒感染嬰兒。
肺炎可以以多種方式來傳播。常見是飛沫傳播，細菌、黴菌或病毒等微生物侵入肺臟而引發的嚴重感染，因而喪失交換氣體的功能。呼吸道同時會產生大量分泌物，導致病患出現呼吸困難、發燒、咳嗽、濃痰等症狀。它們也可以通過從一個或咳嗽噴嚏空氣傳播的飛沫傳播。此外，肺炎可通過血液傳播，尤其是在出生後不久的新生兒。目前需要更多的研究要對不同病原體引起肺炎和傳染方式執行，因為這是用於治療和預防極為重要。
特性:
病毒性和細菌性肺炎的呈遞特徵是相似的。但是，病毒性肺炎的症狀可比細菌性肺炎的症狀更多。在5歲以下的兒童，誰具有咳嗽或呼吸困難，有或沒有發燒情形，診斷肺炎可由快速呼吸時或可見胸壁擴張功能受到限制，其中可見呼吸期間他們的胸部移動或縮回（在健康的人，胸部吸氣時擴張）。喘鳴聲是病毒性感染較為常見。
病危重症的嬰兒可能無法進食或喝水，並可出現失去知覺，低體溫和休克。
風險因素:
雖然大多數健康的孩子能對抗感染有自然的防禦能力，但兒童的免疫系統較差感染肺炎的風險較高。特別是完全沒有母乳餵養的嬰兒，營養不良或營養不足的體弱孩子易造成免疫系統較差
- 現有的疾病，如艾滋病毒感染和麻疹，也增加了感染肺炎的孩子的風險。
以下環境因素也可使兒童易患肺炎：
引起的烹飪和加熱生物質燃料（如木材或糞便）的室內空氣污染
生活在擁擠的家
父母吸煙。
治療
肺炎應該使用抗生素治療。選擇的抗生素是阿莫西林分散片。這是在一個醫療中心當中多數病例肺炎需要口服抗生素。這些情況也可以被社區工作者診斷並使用口服抗生素治療。年齡小於2個月的嬰兒肺炎重症病例建議住院治療。
預防
預防小兒肺炎是一種策略，以降低兒童死亡率的重要組成部分。疫苗接種抵禦Hib，肺炎球菌，麻疹和百日咳（百日咳）是預防肺炎的最有效方法。
充足的營養是關鍵，改善兒童的天然防禦能力，從純母乳餵養和6個月後適當的補充營養品餵養都很重要。除了是有效預防肺炎，這也有利於減少疾病的發生。
解決環境因素，例如保持室內空氣流通減少污染，並鼓勵在擁擠的住所中保持良好的衛生，就可以減少了肺炎生病的兒童人數。
在感染愛滋病毒的兒童中，每日給予抗生素，複方磺胺甲噁唑藥物治療，以減少感染肺炎的危險。
經濟效益
估計66至2015年，國家對孕產婦，新生兒和兒童的孩子治療肺炎，所用抗生素每年的成本約為US $ 109個/百萬。該價格包括抗生素和診斷肺炎的管理及肺炎和腹瀉的控制預算。
世衛組織的應對
世界衛生組織和聯合國兒童基金會結合了肺炎和腹瀉（GAPPD）目標加速肺炎控制措施，以保護，預防和治療小兒肺炎與行動相結合的全球行動計劃：
·保護肺炎包括促進純母乳餵養和6個月後適當的補充營養品餵養
·預防肺炎的疫苗接種，用肥皂洗手，減少家庭空氣污染，愛滋病毒感染者和暴露兒童使用愛滋病預防和複方新諾明藥物的預防
·治療肺炎的重點放在確保每一個患病兒童都有獲得正確的治療-無論是從社區衛生工作者，或在衛生設施，如果病情嚴重-並能得到他們所需要的抗生素和氧氣治療
，包括孟加拉國，印度，烏干達和贊比亞已開發地區，州和國家計劃，以加強對肺炎和腹瀉的控制治療
炎
主要事實
2013年肺炎是全球兒童死亡的主要感染原因，佔5歲以下兒童死亡人數的15％，。
肺炎侵害估計五歲以下的兒童93萬5仟名
肺炎可以由病毒，細菌或真菌引起。
肺炎是可預防，可增強免疫力，給予充分的營養以及加強週遭環境清潔。
由細菌引起的肺炎可用抗生素治療，但只有三分之一的肺炎患兒需要抗生素的治療。
肺炎是急性呼吸道感染，影響肺的形式。肺是由小囊稱為肺泡，當一個健康的人呼吸時會充滿空氣，如果當一個人有肺炎，肺泡充滿了膿和液體，使呼吸產生疼痛並限制吸氧量。
肺炎是世界衛生組織兒童死亡的最大原因。在2013年肺炎殺害估計五歲以下的兒童93萬5仟名，佔兒童死亡人數的15％。肺炎影響的兒童和家庭比比皆是，但最常見的是在南亞和撒哈拉以南非洲地區。它可以用簡單的預防措施進行預防，並用低成本，低含量的藥物和預訪保健治療。孩子們就可以得到保護，免受肺炎感染
原因
肺炎是由許多感染因子，包括病毒，細菌和真菌引起的。最常見的是：
·肺炎鏈球菌-兒童細菌性肺炎的最常見的原因;
·流感嗜血桿菌b型桿菌（Hib） -細菌性肺炎的第二個最常見的原因;
·呼吸道合胞病毒是肺炎的最常見的病毒引起;
·在感染愛滋病毒的嬰兒，肺囊蟲是肺炎最常見的原因，負責至少四分之一的肺炎死亡的愛滋病毒感染嬰兒。
肺炎可以以多種方式來傳播。常見是飛沫傳播，細菌、黴菌或病毒等微生物侵入肺臟而引發的嚴重感染，因而喪失交換氣體的功能。呼吸道同時會產生大量分泌物，導致病患出現呼吸困難、發燒、咳嗽、濃痰等症狀。它們也可以通過從一個或咳嗽噴嚏空氣傳播的飛沫傳播。此外，肺炎可通過血液傳播，尤其是在出生後不久的新生兒。目前需要更多的研究要對不同病原體引起肺炎和傳染方式執行，因為這是用於治療和預防極為重要。
特性:
病毒性和細菌性肺炎的呈遞特徵是相似的。但是，病毒性肺炎的症狀可比細菌性肺炎的症狀更多。在5歲以下的兒童，誰具有咳嗽或呼吸困難，有或沒有發燒情形，診斷肺炎可由快速呼吸時或可見胸壁擴張功能受到限制，其中可見呼吸期間他們的胸部移動或縮回（在健康的人，胸部吸氣時擴張）。喘鳴聲是病毒性感染較為常見。
病危重症的嬰兒可能無法進食或喝水，並可出現失去知覺，低體溫和休克。
風險因素:
雖然大多數健康的孩子能對抗感染有自然的防禦能力，但兒童的免疫系統較差感染肺炎的風險較高。特別是完全沒有母乳餵養的嬰兒，營養不良或營養不足的體弱孩子易造成免疫系統較差
- 現有的疾病，如艾滋病毒感染和麻疹，也增加了感染肺炎的孩子的風險。
以下環境因素也可使兒童易患肺炎：
引起的烹飪和加熱生物質燃料（如木材或糞便）的室內空氣污染
生活在擁擠的家
父母吸煙。
治療
肺炎應該使用抗生素治療。選擇的抗生素是阿莫西林分散片。這是在一個醫療中心當中多數病例肺炎需要口服抗生素。這些情況也可以被社區工作者診斷並使用口服抗生素治療。年齡小於2個月的嬰兒肺炎重症病例建議住院治療。
預防
預防小兒肺炎是一種策略，以降低兒童死亡率的重要組成部分。疫苗接種抵禦Hib，肺炎球菌，麻疹和百日咳（百日咳）是預防肺炎的最有效方法。
充足的營養是關鍵，改善兒童的天然防禦能力，從純母乳餵養和6個月後適當的補充營養品餵養都很重要。除了是有效預防肺炎，這也有利於減少疾病的發生。
解決環境因素，例如保持室內空氣流通減少污染，並鼓勵在擁擠的住所中保持良好的衛生，就可以減少了肺炎生病的兒童人數。
在感染愛滋病毒的兒童中，每日給予抗生素，複方磺胺甲噁唑藥物治療，以減少感染肺炎的危險。
經濟效益
估計66至2015年，國家對孕產婦，新生兒和兒童的孩子治療肺炎，所用抗生素每年的成本約為US $ 109個/百萬。該價格包括抗生素和診斷肺炎的管理及肺炎和腹瀉的控制預算。
世衛組織的應對
世界衛生組織和聯合國兒童基金會結合了肺炎和腹瀉（GAPPD）目標加速肺炎控制措施，以保護，預防和治療小兒肺炎與行動相結合的全球行動計劃：
·保護肺炎包括促進純母乳餵養和6個月後適當的補充營養品餵養
·預防肺炎的疫苗接種，用肥皂洗手，減少家庭空氣污染，愛滋病毒感染者和暴露兒童使用愛滋病預防和複方新諾明藥物的預防
·治療肺炎的重點放在確保每一個患病兒童都有獲得正確的治療-無論是從社區衛生工作者，或在衛生設施，如果病情嚴重-並能得到他們所需要的抗生素和氧氣治療
，包括孟加拉國，印度，烏干達和贊比亞已開發地區，州和國家計劃，以加強對肺炎和腹瀉的控制治療
Pneumonia
Key facts
·Pneumonia is the leading infectious cause of death in children worldwide, accounting for 15% of all deaths of children under 5 years old.
·Pneumonia killed an estimated 935 000 children under the age of five in 2013.
·Pneumonia can be caused by viruses, bacteria or fungi.
·Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors.
·Pneumonia caused by bacteria can be treated with antibiotics, but only one third of children with pneumonia receive the antibiotics they need.
Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.
Pneumonia is the single largest infectious cause of death in children worldwide. Pneumonia killed an estimated 935 000 children under the age of five in 2013, accounting for 15% of all deaths of children under five years old. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. Children can be protected from pneumonia, it can be prevented with simple interventions, and treated with low-cost, low-tech medication and care.
Causes
Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are:
·Streptococcus pneumoniae– the most common cause of bacterial pneumonia in children;
·Haemophilus influenzaetype b (Hib) – the second most common cause of bacterial pneumonia;
·respiratory syncytial virus is the most common viral cause of pneumonia;
·in infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.
Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this is of critical importance for treatment and prevention.
Presenting features
The presenting features of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia. In children under 5 years of age, who have cough and/or difficult breathing, with or without fever, pneumonia is diagnosed by the presence of either fast breathing or lower chest wall indrawing where their chest moves in or retracts during inhalation (in a healthy person, the chest expands during inhalation). Wheezing is more common in viral infections.
Very severely ill infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.
Risk factors
While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child's immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed.
Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia.
The following environmental factors also increase a child's susceptibility to pneumonia:
·indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)
·living in crowded homes
·parental smoking.
Treatment
Pneumonia should be treated with antibiotics. The antibiotic of choice is amoxicillin dispersable tablets. Most cases of pneumonia require oral antibiotics, which are often prescribed at a health centre. These cases can also be diagnosed and treated with inexpensive oral antibiotics at the community level by trained community health workers. Hospitalization is recommended only for severe cases of pneumonia, and for all cases of pneumonia in infants younger than 2 months of age.
Prevention
Preventing pneumonia in children is an essential component of a strategy to reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.
Adequate nutrition is key to improving children's natural defences, starting with exclusive breastfeeding for the first 6 months of life. In addition to being effective in preventing pneumonia, it also helps to reduce the length of the illness if a child does become ill.
Addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.
In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of contracting pneumonia.
Economic costs
The cost of antibiotic treatment for all children with pneumonia in 66 of the countdown to 2015 countries for maternal, newborn and child survival is estimated at around US$ 109 million per year. The price includes the antibiotics and diagnostics for pneumonia management.
WHO response
The WHO and UNICEF integrated Global action plan for pneumonia and diarrhoea (GAPPD) aims to accelerate pneumonia control with a combination of interventions to protect, prevent, and treat pneumonia in children with actions to:
·protectchildren from pneumonia including promoting exclusive breastfeeding and adequate complementary feeding;
·preventpneumonia with vaccinations, hand washing with soap, reducing household air pollution, HIV prevention and cotrimoxazole prophylaxis for HIV-infected and exposed children;
·treatpneumonia focusing on making sure that every sick child has access to the right kind of care -- either from a community-based health worker, or in a health facility if the disease is severe -- and can get the antibiotics and oxygen they need to get well;
A number of countries including Bangladesh, India, Uganda and Zambia have developed district, state and national plans to intensify actions for the control of pneumonia and diarrhoea.
炎
主要事實
2013年肺炎是全球兒童死亡的主要感染原因，佔5歲以下兒童死亡人數的15％，。
肺炎侵害估計五歲以下的兒童93萬5仟名
肺炎可以由病毒，細菌或真菌引起。
肺炎是可預防，可增強免疫力，給予充分的營養以及加強週遭環境清潔。
由細菌引起的肺炎可用抗生素治療，但只有三分之一的肺炎患兒需要抗生素的治療。
肺炎是急性呼吸道感染，影響肺的形式。肺是由小囊稱為肺泡，當一個健康的人呼吸時會充滿空氣，如果當一個人有肺炎，肺泡充滿了膿和液體，使呼吸產生疼痛並限制吸氧量。
肺炎是世界衛生組織兒童死亡的最大原因。在2013年肺炎殺害估計五歲以下的兒童93萬5仟名，佔兒童死亡人數的15％。肺炎影響的兒童和家庭比比皆是，但最常見的是在南亞和撒哈拉以南非洲地區。它可以用簡單的預防措施進行預防，並用低成本，低含量的藥物和預訪保健治療。孩子們就可以得到保護，免受肺炎感染
原因
肺炎是由許多感染因子，包括病毒，細菌和真菌引起的。最常見的是：
·肺炎鏈球菌-兒童細菌性肺炎的最常見的原因;
·流感嗜血桿菌b型桿菌（Hib） -細菌性肺炎的第二個最常見的原因;
·呼吸道合胞病毒是肺炎的最常見的病毒引起;
·在感染愛滋病毒的嬰兒，肺囊蟲是肺炎最常見的原因，負責至少四分之一的肺炎死亡的愛滋病毒感染嬰兒。
肺炎可以以多種方式來傳播。常見是飛沫傳播，細菌、黴菌或病毒等微生物侵入肺臟而引發的嚴重感染，因而喪失交換氣體的功能。呼吸道同時會產生大量分泌物，導致病患出現呼吸困難、發燒、咳嗽、濃痰等症狀。它們也可以通過從一個或咳嗽噴嚏空氣傳播的飛沫傳播。此外，肺炎可通過血液傳播，尤其是在出生後不久的新生兒。目前需要更多的研究要對不同病原體引起肺炎和傳染方式執行，因為這是用於治療和預防極為重要。
特性:
病毒性和細菌性肺炎的呈遞特徵是相似的。但是，病毒性肺炎的症狀可比細菌性肺炎的症狀更多。在5歲以下的兒童，誰具有咳嗽或呼吸困難，有或沒有發燒情形，診斷肺炎可由快速呼吸時或可見胸壁擴張功能受到限制，其中可見呼吸期間他們的胸部移動或縮回（在健康的人，胸部吸氣時擴張）。喘鳴聲是病毒性感染較為常見。
病危重症的嬰兒可能無法進食或喝水，並可出現失去知覺，低體溫和休克。
風險因素:
雖然大多數健康的孩子能對抗感染有自然的防禦能力，但兒童的免疫系統較差感染肺炎的風險較高。特別是完全沒有母乳餵養的嬰兒，營養不良或營養不足的體弱孩子易造成免疫系統較差
- 現有的疾病，如艾滋病毒感染和麻疹，也增加了感染肺炎的孩子的風險。
以下環境因素也可使兒童易患肺炎：
引起的烹飪和加熱生物質燃料（如木材或糞便）的室內空氣污染
生活在擁擠的家
父母吸煙。
治療
肺炎應該使用抗生素治療。選擇的抗生素是阿莫西林分散片。這是在一個醫療中心當中多數病例肺炎需要口服抗生素。這些情況也可以被社區工作者診斷並使用口服抗生素治療。年齡小於2個月的嬰兒肺炎重症病例建議住院治療。
預防
預防小兒肺炎是一種策略，以降低兒童死亡率的重要組成部分。疫苗接種抵禦Hib，肺炎球菌，麻疹和百日咳（百日咳）是預防肺炎的最有效方法。
充足的營養是關鍵，改善兒童的天然防禦能力，從純母乳餵養和6個月後適當的補充營養品餵養都很重要。除了是有效預防肺炎，這也有利於減少疾病的發生。
解決環境因素，例如保持室內空氣流通減少污染，並鼓勵在擁擠的住所中保持良好的衛生，就可以減少了肺炎生病的兒童人數。
在感染愛滋病毒的兒童中，每日給予抗生素，複方磺胺甲噁唑藥物治療，以減少感染肺炎的危險。
經濟效益
估計66至2015年，國家對孕產婦，新生兒和兒童的孩子治療肺炎，所用抗生素每年的成本約為US $ 109個/百萬。該價格包括抗生素和診斷肺炎的管理及肺炎和腹瀉的控制預算。
世衛組織的應對
世界衛生組織和聯合國兒童基金會結合了肺炎和腹瀉（GAPPD）目標加速肺炎控制措施，以保護，預防和治療小兒肺炎與行動相結合的全球行動計劃：
·保護肺炎包括促進純母乳餵養和6個月後適當的補充營養品餵養
·預防肺炎的疫苗接種，用肥皂洗手，減少家庭空氣污染，愛滋病毒感染者和暴露兒童使用愛滋病預防和複方新諾明藥物的預防
·治療肺炎的重點放在確保每一個患病兒童都有獲得正確的治療-無論是從社區衛生工作者，或在衛生設施，如果病情嚴重-並能得到他們所需要的抗生素和氧氣治療
，包括孟加拉國，印度，烏干達和贊比亞已開發地區，州和國家計劃，以加強對肺炎和腹瀉的控制治療
Pneumonia
Key facts
·Pneumonia is the leading infectious cause of death in children worldwide, accounting for 15% of all deaths of children under 5 years old.
·Pneumonia killed an estimated 935 000 children under the age of five in 2013.
·Pneumonia can be caused by viruses, bacteria or fungi.
·Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors.
·Pneumonia caused by bacteria can be treated with antibiotics, but only one third of children with pneumonia receive the antibiotics they need.
Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.
Pneumonia is the single largest infectious cause of death in children worldwide. Pneumonia killed an estimated 935 000 children under the age of five in 2013, accounting for 15% of all deaths of children under five years old. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. Children can be protected from pneumonia, it can be prevented with simple interventions, and treated with low-cost, low-tech medication and care.
Causes
Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are:
·Streptococcus pneumoniae– the most common cause of bacterial pneumonia in children;
·Haemophilus influenzaetype b (Hib) – the second most common cause of bacterial pneumonia;
·respiratory syncytial virus is the most common viral cause of pneumonia;
·in infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.
Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this is of critical importance for treatment and prevention.
Presenting features
The presenting features of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia. In children under 5 years of age, who have cough and/or difficult breathing, with or without fever, pneumonia is diagnosed by the presence of either fast breathing or lower chest wall indrawing where their chest moves in or retracts during inhalation (in a healthy person, the chest expands during inhalation). Wheezing is more common in viral infections.
Very severely ill infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.
Risk factors
While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child's immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed.
Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia.
The following environmental factors also increase a child's susceptibility to pneumonia:
·indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)
·living in crowded homes
·parental smoking.
Treatment
Pneumonia should be treated with antibiotics. The antibiotic of choice is amoxicillin dispersable tablets. Most cases of pneumonia require oral antibiotics, which are often prescribed at a health centre. These cases can also be diagnosed and treated with inexpensive oral antibiotics at the community level by trained community health workers. Hospitalization is recommended only for severe cases of pneumonia, and for all cases of pneumonia in infants younger than 2 months of age.
Prevention
Preventing pneumonia in children is an essential component of a strategy to reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.
Adequate nutrition is key to improving children's natural defences, starting with exclusive breastfeeding for the first 6 months of life. In addition to being effective in preventing pneumonia, it also helps to reduce the length of the illness if a child does become ill.
Addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.
In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of contracting pneumonia.
Economic costs
The cost of antibiotic treatment for all children with pneumonia in 66 of the countdown to 2015 countries for maternal, newborn and child survival is estimated at around US$ 109 million per year. The price includes the antibiotics and diagnostics for pneumonia management.
WHO response
The WHO and UNICEF integrated Global action plan for pneumonia and diarrhoea (GAPPD) aims to accelerate pneumonia control with a combination of interventions to protect, prevent, and treat pneumonia in children with actions to:
·protectchildren from pneumonia including promoting exclusive breastfeeding and adequate complementary feeding;
·preventpneumonia with vaccinations, hand washing with soap, reducing household air pollution, HIV prevention and cotrimoxazole prophylaxis for HIV-infected and exposed children;
·treatpneumonia focusing on making sure that every sick child has access to the right kind of care -- either from a community-based health worker, or in a health facility if the disease is severe -- and can get the antibiotics and oxygen they need to get well;
A number of countries including Bangladesh, India, Uganda and Zambia have developed district, state and national plans to intensify actions for the control of pneumonia and diarrhoea.
炎
主要事實
2013年肺炎是全球兒童死亡的主要感染原因，佔5歲以下兒童死亡人數的15％，。
肺炎侵害估計五歲以下的兒童93萬5仟名
肺炎可以由病毒，細菌或真菌引起。
肺炎是可預防，可增強免疫力，給予充分的營養以及加強週遭環境清潔。
由細菌引起的肺炎可用抗生素治療，但只有三分之一的肺炎患兒需要抗生素的治療。
肺炎是急性呼吸道感染，影響肺的形式。肺是由小囊稱為肺泡，當一個健康的人呼吸時會充滿空氣，如果當一個人有肺炎，肺泡充滿了膿和液體，使呼吸產生疼痛並限制吸氧量。
肺炎是世界衛生組織兒童死亡的最大原因。在2013年肺炎殺害估計五歲以下的兒童93萬5仟名，佔兒童死亡人數的15％。肺炎影響的兒童和家庭比比皆是，但最常見的是在南亞和撒哈拉以南非洲地區。它可以用簡單的預防措施進行預防，並用低成本，低含量的藥物和預訪保健治療。孩子們就可以得到保護，免受肺炎感染
原因
肺炎是由許多感染因子，包括病毒，細菌和真菌引起的。最常見的是：
·肺炎鏈球菌-兒童細菌性肺炎的最常見的原因;
·流感嗜血桿菌b型桿菌（Hib） -細菌性肺炎的第二個最常見的原因;
·呼吸道合胞病毒是肺炎的最常見的病毒引起;
·在感染愛滋病毒的嬰兒，肺囊蟲是肺炎最常見的原因，負責至少四分之一的肺炎死亡的愛滋病毒感染嬰兒。
肺炎可以以多種方式來傳播。常見是飛沫傳播，細菌、黴菌或病毒等微生物侵入肺臟而引發的嚴重感染，因而喪失交換氣體的功能。呼吸道同時會產生大量分泌物，導致病患出現呼吸困難、發燒、咳嗽、濃痰等症狀。它們也可以通過從一個或咳嗽噴嚏空氣傳播的飛沫傳播。此外，肺炎可通過血液傳播，尤其是在出生後不久的新生兒。目前需要更多的研究要對不同病原體引起肺炎和傳染方式執行，因為這是用於治療和預防極為重要。
特性:
病毒性和細菌性肺炎的呈遞特徵是相似的。但是，病毒性肺炎的症狀可比細菌性肺炎的症狀更多。在5歲以下的兒童，誰具有咳嗽或呼吸困難，有或沒有發燒情形，診斷肺炎可由快速呼吸時或可見胸壁擴張功能受到限制，其中可見呼吸期間他們的胸部移動或縮回（在健康的人，胸部吸氣時擴張）。喘鳴聲是病毒性感染較為常見。
病危重症的嬰兒可能無法進食或喝水，並可出現失去知覺，低體溫和休克。
風險因素:
雖然大多數健康的孩子能對抗感染有自然的防禦能力，但兒童的免疫系統較差感染肺炎的風險較高。特別是完全沒有母乳餵養的嬰兒，營養不良或營養不足的體弱孩子易造成免疫系統較差
- 現有的疾病，如艾滋病毒感染和麻疹，也增加了感染肺炎的孩子的風險。
以下環境因素也可使兒童易患肺炎：
引起的烹飪和加熱生物質燃料（如木材或糞便）的室內空氣污染
生活在擁擠的家
父母吸煙。
治療
肺炎應該使用抗生素治療。選擇的抗生素是阿莫西林分散片。這是在一個醫療中心當中多數病例肺炎需要口服抗生素。這些情況也可以被社區工作者診斷並使用口服抗生素治療。年齡小於2個月的嬰兒肺炎重症病例建議住院治療。
預防
預防小兒肺炎是一種策略，以降低兒童死亡率的重要組成部分。疫苗接種抵禦Hib，肺炎球菌，麻疹和百日咳（百日咳）是預防肺炎的最有效方法。
充足的營養是關鍵，改善兒童的天然防禦能力，從純母乳餵養和6個月後適當的補充營養品餵養都很重要。除了是有效預防肺炎，這也有利於減少疾病的發生。
解決環境因素，例如保持室內空氣流通減少污染，並鼓勵在擁擠的住所中保持良好的衛生，就可以減少了肺炎生病的兒童人數。
在感染愛滋病毒的兒童中，每日給予抗生素，複方磺胺甲噁唑藥物治療，以減少感染肺炎的危險。
經濟效益
估計66至2015年，國家對孕產婦，新生兒和兒童的孩子治療肺炎，所用抗生素每年的成本約為US $ 109個/百萬。該價格包括抗生素和診斷肺炎的管理及肺炎和腹瀉的控制預算。
世衛組織的應對
世界衛生組織和聯合國兒童基金會結合了肺炎和腹瀉（GAPPD）目標加速肺炎控制措施，以保護，預防和治療小兒肺炎與行動相結合的全球行動計劃：
·保護肺炎包括促進純母乳餵養和6個月後適當的補充營養品餵養
·預防肺炎的疫苗接種，用肥皂洗手，減少家庭空氣污染，愛滋病毒感染者和暴露兒童使用愛滋病預防和複方新諾明藥物的預防
·治療肺炎的重點放在確保每一個患病兒童都有獲得正確的治療-無論是從社區衛生工作者，或在衛生設施，如果病情嚴重-並能得到他們所需要的抗生素和氧氣治療
，包括孟加拉國，印度，烏干達和贊比亞已開發地區，州和國家計劃，以加強對肺炎和腹瀉的控制治療
Pneumonia
Key facts
·Pneumonia is the leading infectious cause of death in children worldwide, accounting for 15% of all deaths of children under 5 years old.
·Pneumonia killed an estimated 935 000 children under the age of five in 2013.
·Pneumonia can be caused by viruses, bacteria or fungi.
·Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors.
·Pneumonia caused by bacteria can be treated with antibiotics, but only one third of children with pneumonia receive the antibiotics they need.
Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.
Pneumonia is the single largest infectious cause of death in children worldwide. Pneumonia killed an estimated 935 000 children under the age of five in 2013, accounting for 15% of all deaths of children under five years old. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. Children can be protected from pneumonia, it can be prevented with simple interventions, and treated with low-cost, low-tech medication and care.
Causes
Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are:
·Streptococcus pneumoniae– the most common cause of bacterial pneumonia in children;
·Haemophilus influenzaetype b (Hib) – the second most common cause of bacterial pneumonia;
·respiratory syncytial virus is the most common viral cause of pneumonia;
·in infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.
Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this is of critical importance for treatment and prevention.
Presenting features
The presenting features of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia. In children under 5 years of age, who have cough and/or difficult breathing, with or without fever, pneumonia is diagnosed by the presence of either fast breathing or lower chest wall indrawing where their chest moves in or retracts during inhalation (in a healthy person, the chest expands during inhalation). Wheezing is more common in viral infections.
Very severely ill infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.
Risk factors
While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child's immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed.
Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia.
The following environmental factors also increase a child's susceptibility to pneumonia:
·indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)
·living in crowded homes
·parental smoking.
Treatment
Pneumonia should be treated with antibiotics. The antibiotic of choice is amoxicillin dispersable tablets. Most cases of pneumonia require oral antibiotics, which are often prescribed at a health centre. These cases can also be diagnosed and treated with inexpensive oral antibiotics at the community level by trained community health workers. Hospitalization is recommended only for severe cases of pneumonia, and for all cases of pneumonia in infants younger than 2 months of age.
Prevention
Preventing pneumonia in children is an essential component of a strategy to reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.
Adequate nutrition is key to improving children's natural defences, starting with exclusive breastfeeding for the first 6 months of life. In addition to being effective in preventing pneumonia, it also helps to reduce the length of the illness if a child does become ill.
Addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.
In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of contracting pneumonia.
Economic costs
The cost of antibiotic treatment for all children with pneumonia in 66 of the countdown to 2015 countries for maternal, newborn and child survival is estimated at around US$ 109 million per year. The price includes the antibiotics and diagnostics for pneumonia management.
WHO response
The WHO and UNICEF integrated Global action plan for pneumonia and diarrhoea (GAPPD) aims to accelerate pneumonia control with a combination of interventions to protect, prevent, and treat pneumonia in children with actions to:
·protectchildren from pneumonia including promoting exclusive breastfeeding and adequate complementary feeding;
·preventpneumonia with vaccinations, hand washing with soap, reducing household air pollution, HIV prevention and cotrimoxazole prophylaxis for HIV-infected and exposed children;
·treatpneumonia focusing on making sure that every sick child has access to the right kind of care -- either from a community-based health worker, or in a health facility if the disease is severe -- and can get the antibiotics and oxygen they need to get well;
A number of countries including Bangladesh, India, Uganda and Zambia have developed district, state and national plans to intensify actions for the control of pneumonia and diarrhoea.
炎
主要事實
2013年肺炎是全球兒童死亡的主要感染原因，佔5歲以下兒童死亡人數的15％，。
肺炎侵害估計五歲以下的兒童93萬5仟名
肺炎可以由病毒，細菌或真菌引起。
肺炎是可預防，可增強免疫力，給予充分的營養以及加強週遭環境清潔。
由細菌引起的肺炎可用抗生素治療，但只有三分之一的肺炎患兒需要抗生素的治療。
肺炎是急性呼吸道感染，影響肺的形式。肺是由小囊稱為肺泡，當一個健康的人呼吸時會充滿空氣，如果當一個人有肺炎，肺泡充滿了膿和液體，使呼吸產生疼痛並限制吸氧量。
肺炎是世界衛生組織兒童死亡的最大原因。在2013年肺炎殺害估計五歲以下的兒童93萬5仟名，佔兒童死亡人數的15％。肺炎影響的兒童和家庭比比皆是，但最常見的是在南亞和撒哈拉以南非洲地區。它可以用簡單的預防措施進行預防，並用低成本，低含量的藥物和預訪保健治療。孩子們就可以得到保護，免受肺炎感染
原因
肺炎是由許多感染因子，包括病毒，細菌和真菌引起的。最常見的是：
·肺炎鏈球菌-兒童細菌性肺炎的最常見的原因;
·流感嗜血桿菌b型桿菌（Hib） -細菌性肺炎的第二個最常見的原因;
·呼吸道合胞病毒是肺炎的最常見的病毒引起;
·在感染愛滋病毒的嬰兒，肺囊蟲是肺炎最常見的原因，負責至少四分之一的肺炎死亡的愛滋病毒感染嬰兒。
肺炎可以以多種方式來傳播。常見是飛沫傳播，細菌、黴菌或病毒等微生物侵入肺臟而引發的嚴重感染，因而喪失交換氣體的功能。呼吸道同時會產生大量分泌物，導致病患出現呼吸困難、發燒、咳嗽、濃痰等症狀。它們也可以通過從一個或咳嗽噴嚏空氣傳播的飛沫傳播。此外，肺炎可通過血液傳播，尤其是在出生後不久的新生兒。目前需要更多的研究要對不同病原體引起肺炎和傳染方式執行，因為這是用於治療和預防極為重要。
特性:
病毒性和細菌性肺炎的呈遞特徵是相似的。但是，病毒性肺炎的症狀可比細菌性肺炎的症狀更多。在5歲以下的兒童，誰具有咳嗽或呼吸困難，有或沒有發燒情形，診斷肺炎可由快速呼吸時或可見胸壁擴張功能受到限制，其中可見呼吸期間他們的胸部移動或縮回（在健康的人，胸部吸氣時擴張）。喘鳴聲是病毒性感染較為常見。
病危重症的嬰兒可能無法進食或喝水，並可出現失去知覺，低體溫和休克。
風險因素:
雖然大多數健康的孩子能對抗感染有自然的防禦能力，但兒童的免疫系統較差感染肺炎的風險較高。特別是完全沒有母乳餵養的嬰兒，營養不良或營養不足的體弱孩子易造成免疫系統較差
- 現有的疾病，如艾滋病毒感染和麻疹，也增加了感染肺炎的孩子的風險。
以下環境因素也可使兒童易患肺炎：
引起的烹飪和加熱生物質燃料（如木材或糞便）的室內空氣污染
生活在擁擠的家
父母吸煙。
治療
肺炎應該使用抗生素治療。選擇的抗生素是阿莫西林分散片。這是在一個醫療中心當中多數病例肺炎需要口服抗生素。這些情況也可以被社區工作者診斷並使用口服抗生素治療。年齡小於2個月的嬰兒肺炎重症病例建議住院治療。
預防
預防小兒肺炎是一種策略，以降低兒童死亡率的重要組成部分。疫苗接種抵禦Hib，肺炎球菌，麻疹和百日咳（百日咳）是預防肺炎的最有效方法。
充足的營養是關鍵，改善兒童的天然防禦能力，從純母乳餵養和6個月後適當的補充營養品餵養都很重要。除了是有效預防肺炎，這也有利於減少疾病的發生。
解決環境因素，例如保持室內空氣流通減少污染，並鼓勵在擁擠的住所中保持良好的衛生，就可以減少了肺炎生病的兒童人數。
在感染愛滋病毒的兒童中，每日給予抗生素，複方磺胺甲噁唑藥物治療，以減少感染肺炎的危險。
經濟效益
估計66至2015年，國家對孕產婦，新生兒和兒童的孩子治療肺炎，所用抗生素每年的成本約為US $ 109個/百萬。該價格包括抗生素和診斷肺炎的管理及肺炎和腹瀉的控制預算。
世衛組織的應對
世界衛生組織和聯合國兒童基金會結合了肺炎和腹瀉（GAPPD）目標加速肺炎控制措施，以保護，預防和治療小兒肺炎與行動相結合的全球行動計劃：
·保護肺炎包括促進純母乳餵養和6個月後適當的補充營養品餵養
·預防肺炎的疫苗接種，用肥皂洗手，減少家庭空氣污染，愛滋病毒感染者和暴露兒童使用愛滋病預防和複方新諾明藥物的預防
·治療肺炎的重點放在確保每一個患病兒童都有獲得正確的治療-無論是從社區衛生工作者，或在衛生設施，如果病情嚴重-並能得到他們所需要的抗生素和氧氣治療
，包括孟加拉國，印度，烏干達和贊比亞已開發地區，州和國家計劃，以加強對肺炎和腹瀉的控制治療
Pneumonia
Key facts
·Pneumonia is the leading infectious cause of death in children worldwide, accounting for 15% of all deaths of children under 5 years old.
·Pneumonia killed an estimated 935 000 children under the age of five in 2013.
·Pneumonia can be caused by viruses, bacteria or fungi.
·Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors.
·Pneumonia caused by bacteria can be treated with antibiotics, but only one third of children with pneumonia receive the antibiotics they need.
Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.
Pneumonia is the single largest infectious cause of death in children worldwide. Pneumonia killed an estimated 935 000 children under the age of five in 2013, accounting for 15% of all deaths of children under five years old. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. Children can be protected from pneumonia, it can be prevented with simple interventions, and treated with low-cost, low-tech medication and care.
Causes
Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are:
·Streptococcus pneumoniae– the most common cause of bacterial pneumonia in children;
·Haemophilus influenzaetype b (Hib) – the second most common cause of bacterial pneumonia;
·respiratory syncytial virus is the most common viral cause of pneumonia;
·in infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.
Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this is of critical importance for treatment and prevention.
Presenting features
The presenting features of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia. In children under 5 years of age, who have cough and/or difficult breathing, with or without fever, pneumonia is diagnosed by the presence of either fast breathing or lower chest wall indrawing where their chest moves in or retracts during inhalation (in a healthy person, the chest expands during inhalation). Wheezing is more common in viral infections.
Very severely ill infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.
Risk factors
While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child's immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed.
Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia.
The following environmental factors also increase a child's susceptibility to pneumonia:
·indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)
·living in crowded homes
·parental smoking.
Treatment
Pneumonia should be treated with antibiotics. The antibiotic of choice is amoxicillin dispersable tablets. Most cases of pneumonia require oral antibiotics, which are often prescribed at a health centre. These cases can also be diagnosed and treated with inexpensive oral antibiotics at the community level by trained community health workers. Hospitalization is recommended only for severe cases of pneumonia, and for all cases of pneumonia in infants younger than 2 months of age.
Prevention
Preventing pneumonia in children is an essential component of a strategy to reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.
Adequate nutrition is key to improving children's natural defences, starting with exclusive breastfeeding for the first 6 months of life. In addition to being effective in preventing pneumonia, it also helps to reduce the length of the illness if a child does become ill.
Addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.
In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of contracting pneumonia.
Economic costs
The cost of antibiotic treatment for all children with pneumonia in 66 of the countdown to 2015 countries for maternal, newborn and child survival is estimated at around US$ 109 million per year. The price includes the antibiotics and diagnostics for pneumonia management.
WHO response
The WHO and UNICEF integrated Global action plan for pneumonia and diarrhoea (GAPPD) aims to accelerate pneumonia control with a combination of interventions to protect, prevent, and treat pneumonia in children with actions to:
·protectchildren from pneumonia including promoting exclusive breastfeeding and adequate complementary feeding;
·preventpneumonia with vaccinations, hand washing with soap, reducing household air pollution, HIV prevention and cotrimoxazole prophylaxis for HIV-infected and exposed children;
·treatpneumonia focusing on making sure that every sick child has access to the right kind of care -- either from a community-based health worker, or in a health facility if the disease is severe -- and can get the antibiotics and oxygen they need to get well;
A number of countries including Bangladesh, India, Uganda and Zambia have developed district, state and national plans to intensify actions for the control of pneumonia and diarrhoea.