Incubation period days

Period of communicability is as long as secretions are produced in the clinical case, but the importance of healthy carriers is unclear, with some possibly responsible for producing infection in the young or elderly over considerable periods of time. Adequate treatment should render the case or carrier non-infectious within 2 days.

Occurrence and distribution Worldwide distribution, especially in developing countries, with ARI being a major cause of mortality in children. It is one of the commonest causes of terminal pneumonia in the elderly in the developed world. Overcrowding and deprived socio-economic conditions favour the disease. Miners and people living in smoke-filled huts, such as in Papua New Guinea, have an increased incidence.

Control and prevention Active management and treatment of cases of ARI and pneumonia should be carried out as outlined in

Section 13.2 and in the same way as for otitis media in Section 13.9. Family planning and the reduction of overcrowding should be advocated; smoking and having open fires in the main living part of the house should be discouraged. Hand-washing and the careful disposal of discharges from nose, throat and the infected eye should be practised.

A polysaccharide vaccine provides approximately 65% efficacy in adults and can be used in high-risk patients, such as healthy elderly adults living in institutions, patients with chronic organ failure, those with immunodeficiencies, splenectomized children and those with sickle cell disease. Unfortunately, the vaccine has limited efficacy in children under 2 years of age and, therefore, cannot be included in the routine childhood vaccination programme, and is not currently used in developing countries where a suitable vaccine would be of most value. However, a conjugate vaccine was introduced into general use in USA in June 2000 for all children 23 months old and younger, and for children 24-59 months of age who are at high risk of serious pneumo-coccal disease. The vaccine has been shown to be highly efficacious against invasive pneumococcal disease, but only moderately efficacious against pneumonia and otitis media. At present, demand is outstripping supply, but depending on the results experienced in USA and supply problems, it is likely that this vaccine will soon be included in routine childhood vaccination programmes in other countries, including the developing world. An alternative strategy may be to vaccinate pregnant women so that maternal antibodies are passed on to the newborn child.

Treatment Penicillin G or erythromycin are effective in the majority of cases, but where resistant strains are found or the child is seriously ill, cotrimoxazole, amoxi-cillin or ampicillin should be used.

Surveillance for ARI will be found in Section 13.2 and for otitis media in Section 13.9.

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