This study examined the spatial distribution of childhood community-acquired pneumonia detected through prospective surveillance in Goiânia, Brazil. Three spatial analysis techniques were applied to detect intra-urban geographic aggregation of pneumonia cases: Kernel method, nearest neighbor hierarchical technique, and spatial scan statistic. A total of 724 pneumonia cases confirmed by chest radiography were identified from May 2000 to August 2001. All cases were geocoded on a digital map. The annual pneumonia risk rate was estimated at 566 cases/100,000 children. Analysis using traditional descriptive epidemiology showed a mosaic distribution of pneumonia rates, while GIS methodologies showed a non-random pattern with hot spots of pneumonia. Cluster analysis by spatial scan statistic identified two high-risk areas for pneumonia occurrence, including one most likely cluster (RR = 2.1; p < 0.01) and one secondary cluster (RR = 1.3; p = 0.01). The data used for the study are in line with recent WHO-led efforts to improve and standardize pediatric pneumonia surveillance in developing countries and show how GIS and spatial analysis can be applied to discriminate target areas of pneumonia for public heath intervention.

Abstract.A cross-sectional study was conducted for assessing the prevalence of and risk factors associated with Cryptosporidium parvum in diarrheic children who were hospitalized in Goiânia, capital of Goiás State in Brazil. A crude prevalence of 14.4% (64 of 445) was observed using a direct immunfluorescent assay (DFA), but the true prevalence was 18.7% (83 of 445) when a gold standard of immunomagnetic separation was used in combination with the DFA. Infection was more predominant in children less than 24 months old (odds ratio [OR] ‫ס‬ 0.50, 90% confidence interval [CI] ‫ס‬ 0.36-0.68, P ‫ס‬ 0.0001), and males were 2.2 times more at risk for infection when compared with females (OR ‫ס‬ 2.2, 90% CI ‫ס‬ 0.13-3.8, P ‫ס‬ 0.01). The socioeconomic, intra-familial, and environmental factors associated with cryptosporidiosis were day care attendance, household children with diarrhea up to 30 days prior to the interview, contact with surface water within past 30 days prior to the interview, dwelling distance from a body of water, and the late rainy season (P < 0.10). C. parvum was not associated with the parent's occupation, household sleeping arrangements, number of caregivers, breast-fed children, diet and type of food hygiene, source and type of treatment of drinking water, presence of sewage, and animal exposure (P > 0.10). Although weight was not found to be associated with infection, children infected with C. parvum weighed on average 2.0% less than children not infected with C. parvum (P > 0.10). Thus, C. parvum is an important etiologic agent of childhood diarrhea and should be identified in routine parasitologic tests of diarrheal stool samples.

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A survey of nasopharyngeal (NP) carriage of penicillin nonsusceptible pneumococcal (PNSp) isolates was conducted among 1,192 children attending 62 day care centers in Brazil, where pneumococcal vaccination has still not been introduced routinely. NP pneumococcal carriage was detected in 686 (57.6%) infants, and 178 (25.9%) of them carried PNSp isolates. Being less than 24 months of age, hospitalization in the previous three months, and recurrent acute otitis media were independently associated with PNSp. Serotypes 14, 23F, 19A, 6A, 6B and 19F were the most common serotype isolated accounting for 80% of the PNSp. A high proportion (35/332) of non(sero)-typeable isolates was detected, 62.9% of them PNSp. Serotypes coverage projected for the PCV13-valent vaccine (72%) was significantly higher compared to PCV7 (58.4%) and PCV10-valent vaccine (59.3%).

Under programme conditions the effectiveness of Hib conjugate vaccine in infants with radiologically confirmed pneumonia was 31% (95% CI: -9%, 57%) showing the potential benefit of Hib immunization in the prevention of likely non-bacteraemic pneumonia.