Perspectives on the burden of pneumonia in children

In the US at the beginning of the 20th century, the infant mortality rate was high (150/1000 live births); 19% of deaths were due to pneumonia. In the pre-antibiotic era, childhood pneumonia case fatality rates were age dependant with most deaths occurring in infants. The introduction of antibiotics in the late 1930s lowered the mortality, but in the US most of the improvements in pneumonia mortality since 1900 had already occurred, probably due to improvements in nutrition and child care. Today, efforts to control pneumonia mortality are focused on case management and vaccines. History suggests that a more holistic approach may be needed.