exposure from the time of conception through childhood ; reducing indoor air pollution ; treating or preventing HIV infection ; giving prophylactic antibiotics in immunosuppressed children ; and preventing mother-to-child HIV transmission . Several of these measures are also appropriate for respiratory disease prevention in adults .
Vaccination is one of the greatest achievements of modern public health , yet many children are unimmunised against preventable infections particularly in low- and middleincome countries . Countries with the lowest immunisation rates account for more than two-thirds of the vaccine-preventable disease burden and have the highest childhood mortality .
Treatment
The success of prevention or treatment of many respiratory infections is dependent on the quality of the healthcare system . Most bacterial infections are treatable with antibiotics and most viral infections are selflimited . Yet millions of people still die of pneumonia . The failure to prevent these deaths often results from lack of access to healthcare and effective preventive interventions including immunisation . Comorbidities , such as HIV infection and malnutrition , and lack of awareness and education may lead to advanced disease before the affected people seek medical attention . Late presentation leads to greater treatment failure .
pneumonia , although its delivery is not available in many low- or middle-income countries . Enhancing availability of oxygen delivery systems in these areas must be a global priority . In the management of adults with pneumonia , several national guidelines have been developed and many studies have documented that adherence to these guidelines is associated with better patient outcomes .
Control and elimination
Vaccines are essential for the control and elimination of many of these childhood diseases . The development of new conjugate vaccines against Streptococcus pneumoniae ( pneumococcus ) and Haemophilus influenza type b have been important advances in prevention of pneumonia . Vaccines against bacteria , such as S . pneumoniae , H . influenza type b and whooping cough ( pertussis ) are highly effective for preventing lower respiratory tract infections . The influenza vaccine is effective in preventing influenza . Vaccines against other viruses , such as measles , are so effective that they are virtually eliminating the diseases . Vaccination programmes for adolescents and adults , which are also effective , have frequently been neglected . Conjugate vaccines must be available as part of expanded programmes for immunisation in all countries . Development of improved vaccines with broader coverage is needed to control or eliminate specific infections .
The most effective way to manage these diseases is through standard case management . Case management is defined as “ a collaborative process of assessment , planning , facilitation , care coordination , evaluation , and advocacy for options and services to meet an individual ’ s and a family ’ s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes ” [ 29 ].
For childhood pneumonia , a standard approach to diagnosis and treatment has been developed by the WHO in the Integrated Management of Childhood Illness programme . The cornerstone of pneumonia management is the appropriate diagnosis and use of antibiotics . Supplemental oxygen is essential for effective treatment of severe
Forum of International Respiratory Societies 17