title: Epidemiology of community-acquired pneumonia in children of Latin America and the Caribbean: a systematic review and meta-analysis.
abstract: BACKGROUND
  This systematic review evaluated the incidence, etiology, and use of resources in bacterial, non-tuberculosis community-acquired pneumonia (CAP) in immune-competent children aged <5 years.
  
  
  METHODS
  Systematic searches (1980-2008) were performed using MEDLINE, Cochrane Library, EMBASE, LILACS, generic, and academic Internet searches. Regional health ministries, the Pan American Health Organization (PAHO), regional proceedings, doctoral theses, and the reference lists of included studies were also searched, and experts were consulted. Arcsine transformations and the DerSimonian-Laird random-effects model were used for proportion meta-analyses.
  
  
  RESULTS
  The search yielded 1220 references; 60 were included in the meta-analysis, giving a total 23 854 CAP episodes with an incidence of 919/100 000 child-years in children aged <5 years. Streptococcus pneumoniae was the most frequently isolated agent (11.08%; 95% confidence interval (CI) 7.63-15.08), and pneumococcal serotype 14 was most prevalent (33.00%; 95% CI 25.95-40.45). Other common agents were Haemophilus influenzae and Mycoplasma pneumoniae. Health economics data on CAP in the region were scarce. About one-fourth of CAP patients required hospitalization (median length of stay 11 days, range 5-13.5 days).
  
  
  CONCLUSIONS
  The burden of CAP was substantial, with S. pneumoniae, H. influenzae, and M. pneumoniae being the most common pathogens identified. High quality primary studies on disease incidence, use of health resources, and standardized data collection on disease burden and circulating strains are essential to provide baseline data for the future evaluation of vaccine impact.
authors: Hospital de Niños Gutiérrez, Calle Beauchef 214, 6° Piso, CP 1424, Buenos Aires, Argentina. angelagentile@fibertel.com.ar
authors: Angela
authors: A
authors: Gentile
authors: Ariel
authors: A
authors: Bardach
authors: Agustín
authors: A
authors: Ciapponi
authors: Sebastian
authors: S
authors: Garcia-Marti
authors: Patricia
authors: P
authors: Aruj
authors: Demian
authors: D
authors: Glujovsky
authors: Juan Ignacio
authors: JI
authors: Calcagno
authors: Agustina
authors: A
authors: Mazzoni
authors: Romulo Ernesto
authors: RE
authors: Colindres
mesh_terms: D017691:Caribbean Region / Q000453:epidemiology; D002648:Child; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology*; D006193:Haemophilus influenzae / Q000472:pathogenicity; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007843:Latin America / Q000453:epidemiology; D009177:Mycoplasma pneumoniae / Q000472:pathogenicity; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000382:microbiology*; D018570:Risk Assessment; D013296:Streptococcus pneumoniae / Q000472:pathogenicity