Air Pollution and Global Pediatric Pneumococcal Disease.

The global burden of mortality from lower respiratory tract infection (LRTI) disproportionately impacts children under 5 years of age in low- and middle-income countries. Streptococcus pneumoniae is the leading pathogenic cause of LRTI morbidity and mortality worldwide. While the global scale-up of childhood pneumococcal vaccination has lowered mortality, air pollution remains a top risk factor for death from LRTI. Climate change will likely alter patterns of exposure to ambient dust, ambient biomass smoke, and household use of higher-polluting fuels. It is therefore important for pediatric infectious disease practitioners to understand the impact of air pollution on the epidemiology of infection from S. pneumoniae and other major respiratory tract pathogens affecting children. This article provides an overview of the available evidence on the impact of pneumococcal pneumonia on child mortality, introduces air pollution concepts, describes mechanisms by which air pollution contributes to respiratory disease, and highlights environmental risk factors for LRTI with a focus on S. pneumoniae.