Abstract:
BACKGROUND. More comprehensive immunisation regimens, strengthening of HIV prevention and management programmes and improved
socioeconomic conditions have impacted on the epidemiology of paediatric community-acquired pneumonia (CAP) in South Africa (SA).
OOBJECTIVES. To summarise effective preventive strategies to reduce the burden of childhood CAP.
METHODS. An expert subgroup reviewed existing SA guidelines and new publications focusing on prevention. Published evidence on
pneumonia prevention informed the revisions; in the absence of evidence, expert opinion was used. Evidence was graded using the British
Thoracic Society (BTS) grading system.
RECOMMENDATIONS. General measures for prevention include minimising exposure to tobacco smoke or air pollution, breastfeeding,
optimising nutrition, optimising maternal health from pregnancy onwards, adequate antenatal care and improvement in socioeconomic
and living conditions. Prevention of viral transmission, including SARS-CoV-2, can be achieved by hand hygiene, environmental
decontamination, use of masks and isolation of infected people. Specific preventive measures include vaccines as contained in the Expanded
Programme on Immunisation schedule, isoniazid prophylaxis for tuberculosis, co-trimoxazole prophylaxis for HIV-infected infants and
children who are immunosuppressed, and timely diagnosis of HIV, as well as antiretroviral therapy (ART) initiation. HIV-infected children
treated with ART from early infancy, and HIV-exposed children, have similar immunogenicity and immune responses to most childhood
vaccines as HIV-unexposed infants.
VALIDATION. These recommendations are based on available published evidence supplemented by the consensus opinion of SA paediatric
experts, and are consistent with those in published international guidelines.
