Population-based surveillance of pediatric pneumonia: use of spatial analysis in an urban area of Central Brazil

Abstract

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.

Impacto da vacina conjugada contra Streptococcus pneumoniae em doenças invasivas

“…16 It is important to emphasize that clinical and radiological definition of pneumonia is very difficult. 4 Nonetheless, a large part of the pneumococcus isolates in Brazil come from pulmonary infections. [38][39][40] Contrary to the findings in the USA, in which the majority of the pneumococcus strains are isolated in patients with bacteremia, in studies coming from Latin America, around 50% of the pneumococci are isolated from persons with pneumonia.…”

“…[1][2][3] In spite of pneumonias causing the largest number of deaths, the mucosal diseases caused by pneumococcus are more common, and the use of antibiotics to treat otitis and sinusitis have been associated with the appearance and dissemination of antibiotic resistant strains. [4][5][6][7] Pneumococcal diseases are more common in children younger than 2 years, elderly people, and in certain groups of individuals that present conditions associated with the development of invasive pneumococcal diseases (IPD) ( Table 2). [1][2][3][4][5][6][7][8][9][10][11][12] Moreover, they affect poorer populations more seriously, aggravating the situation of these populations even further.…”

“…[4][5][6][7] Pneumococcal diseases are more common in children younger than 2 years, elderly people, and in certain groups of individuals that present conditions associated with the development of invasive pneumococcal diseases (IPD) ( Table 2). [1][2][3][4][5][6][7][8][9][10][11][12] Moreover, they affect poorer populations more seriously, aggravating the situation of these populations even further. 1,4 In Brazil, the highest rate of incidence of pneumococcal meningitis has been registered in nursing infants younger than 1 year, and bacterial resistance has increased progressively.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] Moreover, they affect poorer populations more seriously, aggravating the situation of these populations even further. 1,4 In Brazil, the highest rate of incidence of pneumococcal meningitis has been registered in nursing infants younger than 1 year, and bacterial resistance has increased progressively. 6,7,11 From 1983 to 2003, the number of cases of meningitis from pneumococcus was 29,600, with 8,554 deaths.…”

“…11 The number of cases of pneumonia acquired in the community and confirmed by radiological exam in children < 5 years is substantially higher (566/100,000), particularly among children who live in precarious conditions. 4 The importance of pneumococcal diseases and the increase in bacterial resistance have made it essential to develop vaccines to prevent these diseases, since the 23-valent polysaccharide vaccine (PN23), licensed in 1983, is recommended only for people over 2 years of age. 1 The success of conjugate Haemophilus influenzae type b (Hib) vaccines in several countries encouraged the development of new conjugate vaccines against low, in comparison with the benefit obtained from vaccination.…”