Priority Medicines for Europe and the World 2013 Update. Background Paper 6 - Priority Diseases and Reasons for Inclusion. BP 6.22 - Pneumonia
(2013; 55 pages)

The 2004 Priority Medicines for Europe and the World Report had 17 chronic and acute priority diseases whose inclusion were based on data from the World Health Organization (WHO) Global Burden of Disease and Database. This updated 2013 Report revised its methods and found reason for the inclusion of five new priority diseases using both the WHO Global Burden of Disease Database 2008 and the Lancet Global Burden of Disease Study 2010. In addition to previous conditions on the list, the five new priority diseases or risk factors are: obesity, low back pain, neonatal conditions, pneumonia, and hearing loss. This background paper focuses on pneumonia in two high-risk populations: children under five and the elderly. Worldwide, children under five are primarily affected by this disease, followed by adults 65 years and older, together making up the majority of pneumonia deaths especially in Europe.

Poor maternal and child health remains a significant problem in developing countries. Although the under-five mortality rate has dropped 35% since 1990, with every developing region seeing a 30% reduction, progress at the global level to reduce under-five mortality is behind schedule for 2015. Pneumonia remains a major killer of children under five years of age, and the highest under-five mortality rates are in low- and middle-income countries (LMIC), namely in sub-Saharan Africa and in Southern Asia. Children in low-income countries are nearly 18 times more likely to die before the age of five than children in high-income countries due to pneumonia and other acute infections.

As a result, there is a considerable need for effective interventions in all parts of the world in order to bring down mortality and morbidity rates due to pneumonia. Reducing child mortality is one of the eight Millennium Development Goals (MDGs), and one way to reach this target is to reduce pneumonia-related mortality by providing effective treatment promptly. Effective interventions to reduce pneumonia deaths are available through vaccinations and antibiotics. However, access to and information on antibiotic use is limited. In addition, only one in five caregivers know to seek appropriate medical care immediately for children with signs of pneumonia. Currently, rapid diagnostic devices that can be used at point of care are not available.

Rapid diagnostics for distinguishing between viral and bacterial pneumonia is not yet well developed. Existing laboratory tests for certain biochemical markers (e.g. procalcitonin, C-reactive protein, white blood cells, etc) only detect the likelihood of bacterial pneumonia. In addition, clinical signs (e.g. fever, shortness of breath, wheezing, crepitation, etc) and radiographic tests (e.g. consolidation or infiltration in the lung) can confirm or disprove diagnosis of pneumonia. However, it is difficult to differentiate between viral and bacterial pneumonia in resource-poor settings lacking in technology and laboratory equipment. Attention should focus on continued updates on existing pneumococcal vaccines to help match the pattern of disease. More effective and rapid diagnostics would also help play a substantial role in detecting cases of pneumonia in order to treat patients at the earliest onset of the disease. Furthermore, scaling up treatment coverage at a relatively low cost would aid in the reduction of childhood pneumonia mortality. While there are current care management for pneumonia, including interventions involving integration of vaccines into national immunization programs, targeted antibiotic treatments for both severe and non-severe pneumonia, and more accurate and rapid diagnostics will help to reduce the global mortality rates in children under five and the elderly. Preventing children from developing or dying from pneumonia is critical to reducing mortality and working towards achieving the MDG4 in reducing the under-five mortality rate by two thirds by 2015.

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