Community-acquired pneumonia in children

​Routine childhood immunisation with pneumococcal, influenza, Haemophilus influenzae type b (Hib), and pertussis vaccinations is the most important primary prevention strategy to reduce incidence of CAP.[1]Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011 Oct;53(7):e25-76. https://academic.oup.com/cid/article/53/7/e25/424286 http://www.ncbi.nlm.nih.gov/pubmed/21880587?tool=bestpractice.com [3]Haq IJ, Battersby AC, Eastham K, et al. Community acquired pneumonia in children. BMJ. 2017 Mar 2;356:j686. http://www.ncbi.nlm.nih.gov/pubmed/28255071?tool=bestpractice.com ​​ Check your local protocols for details of the recommended immunisation schedule.​​

In the US, the Advisory Committee on Immunization Practices (ACIP) recommends:[15]Centers for Disease Control and Prevention. Child and adolescent immunization schedule by age​: recommendations for ages 18 years or younger, United States, 2024. Nov 2023 [internet publication]. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-age.html

• Routine administration of pneumococcal conjugate vaccine (PCV15 or PCV20) for all children <5 years old, with catch-up vaccination for those aged ≤4 years who missed their primary doses. This is given as a series of four doses, at ages 2 months, 4 months, 6 months, and 12-15 months.

• Routine annual influenza vaccination for all children aged 6 months to 18 years, ideally by the end of October each year. Children aged 6 months to 8 years require two doses (administered ≥4 weeks apart) during their first season of vaccination to optimise response. The ACIP recommends that children aged 6 months to 8 years who have previously received ≥2 doses of trivalent or quadrivalent influenza vaccine ≥4 weeks apart before 1 July require only one dose. From age 9 years onwards, only one annual dose is recommended.

• Routine administration of a conjugate Hib vaccination series of 2 or 3 doses (depending on the specific vaccine), beginning at 2 months of age, plus a booster dose at age 12-15 months. Catch-up vaccination is recommended for those aged ≤4 years who missed their primary doses.

• Routine administration of a 5-dose series of pertussis vaccinations (via the diphtheria, tetanus, and acellular pertussis [DTaP] vaccine), with primary doses at 2, 4, and 6 months and booster doses at 15-18 months and 4-6 years. This is followed by a single dose at age 11-12 years of the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine).

• Immunisation with a single dose of respiratory syncytial virus (RSV) vaccine for infants depending on the vaccination status of their mother.

• Further details on current vaccination schedules and details for specific sub-groups of children can be found in the latest ACIP schedule. CDC: child and adolescent immunization schedule by age (addendum updated June 27, 2024) Opens in new window

The ACIP also recommends use of the long-acting monoclonal antibody nirsevimab for passive immunization against RSV infection for all infants aged <8 months who are born during or entering their first RSV season, and for high-risk infants and children aged 8-19 months who are entering their second RSV season.[16]Jones JM, Fleming-Dutra KE, Prill MM, et al. Use of nirsevimab for the prevention of respiratory syncytial virus disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR Morb Mortal Wkly Rep. 2023 Aug 25;72(34):920-5. https://www.cdc.gov/mmwr/volumes/72/wr/mm7234a4.htm?s_cid=mm7234a4_w http://www.ncbi.nlm.nih.gov/pubmed/37616235?tool=bestpractice.com

The UK Health Security Agency (HSA) recommends the following routine immunisations:[17]UK Health Security Agency. Complete routine immunisation schedule from 1 September 2024. Sep 2024 [internet publication]. https://www.gov.uk/government/publications/the-complete-routine-immunisation-schedule/the-complete-routine-immunisation-schedule-from-february-2022

• Pneumococcal conjugate vaccine (PCV13) at 12 weeks of age, with a booster dose at 1 year old (and catch-up vaccination for any unimmunised or partially immunised child aged ≤9 years). Additional doses are recommended for some risk groups.

• A 3-dose course covering Haemophilus influenzae type b (Hib) and pertussis (via the 6-in-1 vaccine) at 8 weeks, 12 weeks, and 16 weeks, with a booster at 1 year old (and catch-up vaccination for any unimmunised or partially immunised child ≤9 years).

• Annual influenza vaccine (from September 1) for all children aged 2 or 3 years or in school years from reception to year 11 plus any child aged from 6 months to 18 years who is a clinical risk group.

• A single dose of RSV vaccine offered to all pregnant women to protect their infants from infection.

• Further details on current vaccination schedules and details for specific sub-groups of children can be found in the latest UK HSA schedule. UK Health Security Agency: complete routine immunisation schedule from 1 September 2024 Opens in new window

It is also important to educate parents and carers on primary prevention measures (e.g., the importance of hand-washing and other hygiene measures, particularly for children living in crowded homes) and potential risks for infectious exposures in the community. Avoidance of exposure to tobacco smoke is also important.