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Around the world about one in five childhood deaths is from pneumonia. It is a disease of developing countries in particular and the pneumococcus is the major pathogen. In the Gambia (

; see also comment, ibid: 1113–4) a randomised controlled trial of a 9-valent pneumococcal conjugate vaccine has produced impressive results. Vaccine efficacy was 37% against a first episode of radiologically confirmed pneumonia, 7% against a first episode of clinical pneumonia, 77% against invasive disease due to vaccine serotypes, 50% against all pneumococcal disease, 15% against any hospital admission, and 16% against death from any cause. It is concluded that all African infants should have pneumococcal conjugate vaccine made available to them.

The Child Health Epidemiology Reference Group (CHERG) was established by the WHO in 2001 to improve worldwide statistics on mortality in the under fives. Figures from this group for 2000–2003 (

) show that six causes account for almost three-quarters of the 10.6 million deaths per year in this age group. They are pneumonia (19%), diarrhoea (18%), malaria (8%), neonatal pneumonia or sepsis (10%), prematurity (10%), and neonatal asphyxia (8%). The rates of the communicable causes of death are …

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