Etiological profile of community-acquired pneumonia (CAP) and immunization status among children < 5 years in public and private sector

Background: Childhood pneumonia is the leading cause of morbidity in children < 5 years with most cases occurring in India (43million). Pneumonia contributes to 27.5% of total under five year mortality in India.Streptococcus pneumonia, Hemophilus influenzaand respiratory syncytial virus have been identified as responsible pathogens. India’s multi-year plan for immunization highlights needfor accelerated introduction of new and underutilized vaccines against diseases with significant morbidity and mortality. PneumococcalConjugate Vaccines (PCV) have been licensed in India since 2006. The objective of this study was to document the etiology andimmunization status of children < 5 years who were newly diagnosed cases of CAP in private and public sector.Material/Methods: This study was a retrospective review of inpatient records (n=532) of children <5 years diagnosed with CAP in 2hospitals- one private and other public multispecialty hospital that had pediatric ward, pediatric ICU (Intensive Care Unit) and NICU(Neonatal Intensive Care Unit) in Mumbai, India. Cases where primary diagnosis was not clearly documented were confirmed fordiagnosis with laboratory reports and X-rays. Using the electronic case report form, baseline demographic and clinical characteristicssuch as age, gender, date of diagnosis, primary diagnosis on admission, prior immunization, diagnostic and laboratory test, treatmentduring inpatient stay and advice on discharge were extracted.Results: The average age at admission was 1.95 ± 1.45 years in private hospital and 1.51 ± 1.17 years in public hospital. Etiology was notestablished in a majority of the clinical diagnosed CAP cases i.e. 92/105 (93.13 %) in private hospital and 62/67 (92.54 %) in publichospital. Considerable morbidity due to CAP with the average length of stay 5.87 ± 3.50 days in private hospital versus 7.97 ± 4.74 days inpublic hospital was observed. Also 100 % of the children in private hospital received antibiotics versus 95.52 % in the public hospital. Themean duration of antibiotics in private hospital was 4.38 ± 4.61 days and in public hospital 2.1 ± 3.26 days. The number of unvaccinatedchildren or children whose immunization status is not known was significantly higher in the public hospital (34.33 %) than the privatehospital (20.59 %) (p=0.0465)Conclusions:A greater proportion of cases of CAP were classified as unspecified pneumonia due to lack of adequate diagnostic facilitieswhich act as an impediment in establishing etiology of CAP in Indian setting leading to considerable antibiotic use. An important wayforward for India would be to consider a possible timeline to achieve universal childhood immunization through introduction ofvaccines directed against pneumonia in the national immunization program across the country in the remaining states