Community-acquired pneumonia in children

Routine childhood immunization 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 immunization 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 ages ≤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 ages 6 months to 18 years, ideally by the end of October each year. Children ages 6 months to 8 years require two doses (administered ≥4 weeks apart) during their first season of vaccination to optimize response. The ACIP recommends that children ages 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 ages ≤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.

• Immunization 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 subgroups 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 ages <8 months who are born during or entering their first RSV season, and for high-risk infants and children ages 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

It is also important to educate parents and caregivers on primary prevention measures (e.g., the importance of handwashing 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.