Challenges in the diagnosis of paediatric pneumonia in intervention field trials: recommendations from a pneumonia field trial working group

• Type of Material: Article
• Authors: D Goodman, Johns Hopkins University; ME Crocker, Johns Hopkins University; F Pervaiz, Johns Hopkins University; ED McCollum, Johns Hopkins University; Nelson Steenland, Emory University; SM Simkovich, Johns Hopkins University; CH Miele, Johns Hopkins University; LL Hammitt, Johns Hopkins University; P Herrera, Johns Hopkins University; HJ Zar, University of Cape Town; H Campbell, University of Edinburgh; CF Lanata, Instituto de Investigación Nutricional; JP McCracken, Universidad del Valle de Guatemala; Lisa Thompson, Emory University; G Rosa, Emory University; MA Kirby, Emory University; S Garg, Deemed University; G Thangavel, Deemed University; V Thanasekaraan, Deemed University; K Balakrishnan, Deemed University; C King, University College London; Thomas Clasen, Emory University; W Checkley, Johns Hopkins University; Ajay Pillarisetti, Emory University; Azhar Nizam, Emory University; P Barry Ryan, Emory University; Dana Barr, Emory University; Howard Chang, Emory University; Jeremy Sarnat, Emory University; Lance Waller, Emory University; Lisa Elon, Emory University; Usha Ramakrishnan, Emory University
• Language: English
• Date: 2019-12-01
• Publisher: ELSEVIER SCI LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2019 Elsevier Ltd
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/S2213-2600(19)30249-8
• Title of Journal or Parent Work: LANCET RESPIRATORY MEDICINE
• Volume: 7
• Issue: 12
• Start Page: 1068
• End Page: 1083
• Keywords: PNEUMOCOCCAL CONJUGATE VACCINE; Life Sciences & Biomedicine; LOWER RESPIRATORY-INFECTIONS; CHILDHOOD PNEUMONIA; AGED 2-59 MONTHS; Respiratory System; General & Internal Medicine; INDOOR AIR-POLLUTION; POPULATION-BASED SURVEILLANCE; RANDOMIZED CONTROLLED-TRIAL; C-REACTIVE PROTEIN; Science & Technology; RADIOGRAPHICALLY-CONFIRMED PNEUMONIA; COMMUNITY CASE-MANAGEMENT; Critical Care Medicine
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Pneumonia is a leading killer of children younger than 5 years despite high vaccination coverage, improved nutrition, and widespread implementation of the Integrated Management of Childhood Illnesses algorithm. Assessing the effect of interventions on childhood pneumonia is challenging because the choice of case definition and surveillance approach can affect the identification of pneumonia substantially. In anticipation of an intervention trial aimed to reduce childhood pneumonia by lowering household air pollution, we created a working group to provide recommendations regarding study design and implementation. We suggest to, first, select a standard case definition that combines acute (≤14 days) respiratory symptoms and signs and general danger signs with ancillary tests (such as chest imaging and pulse oximetry) to improve pneumonia identification; second, to prioritise active hospital-based pneumonia surveillance over passive case finding or home-based surveillance to reduce the risk of non-differential misclassification of pneumonia and, as a result, a reduced effect size in a randomised trial; and, lastly, to consider longitudinal follow-up of children younger than 1 year, as this age group has the highest incidence of severe pneumonia.