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close this bookWHO Recommended Surveillance Standards (WHO; 1999; 157 pages)
View the documentAcknowledgements
View the documentAcronyms
View the documentIntroduction
View the documentNational Coordination of Communicable Disease Surveillance
View the documentExplanatory notes
View the documentSurveillance activities: criteria and WHO Department
View the documentCommunicable disease contacts in Regional Offices
open this folder and view contentsDiseases
close this folderSyndromes
View the documentAcute haemorrhagic fever syndrome
View the documentAcute lower respiratory tract infections (aLRTI) and Pneumonia
View the documentAcute (watery) diarrhoea
View the documentAcute (bloody) diarrhoea
View the documentAntimicrobial resistance
View the documentAnti-tuberculosis drug resistance
View the documentFoodborne diseases
View the documentSexually transmitted diseases/syndromes
View the documentAnnex 1 Software free and in the public domain
View the documentAnnex 2 Proposed surveillance definitions
View the documentAnnex 3 Role and use of Geographic Information Systems (GIS) and mapping for epidemiological surveillance

Acute lower respiratory tract infections (aLRTI) and Pneumonia


Acute infections of the lower respiratory tract, of which pneumonia is the most deadly, kill more than 4 million people a year, mainly among children <5 years. Acute respiratory tract infections (ARI) are the leading cause of death in that age group; ARI have a major impact on health services and household income, accounting for up to 50% of visits by children to health facilities. Antibiotics are often inappropriately prescribed and used for these conditions.

WHO strategy is to support heath authorities in reducing morbidity and mortality through integrated case management of children at primary and first referral level, in collaboration with other agencies. Surveillance is necessary to monitor disease trends and control programmes, including the provision and use of essential drugs.


Clinical case definition and classification



Symptoms: Cough or difficult breathing and

Signs: breathing >50/minute for infant aged 2 months to < 1 year breathing >40/minute for child aged 1 to 5 years and no chest indrawing, stridor or danger signs.



Symptoms: cough or difficult breathing + any general danger sign or chest indrawing or stridor in a calm child.

General danger signs:

For children aged 2 months to 5 years.

Unable to drink or breast feed, vomits everything, convulsions, lethargic or unconscious.


Routine monthly aggregated reporting from peripheral to intermediate and central level.

Community surveys/sentinel surveillance to complement routine data and for the evaluation of control programme activities.

Sentinel surveillance reporting monthly to intermediate and central level. Quarterly reporting of community/household surveys from peripheral to central level.


Aggregated data for reporting

Number of cases by age, severity, geographical area, treatment (Y/N), hospitalization (Y/N), outcome.



• Cases/incidence by month, geographical area, age, sex
• Comparisons with same month, age group and geographical area in previous years
• Information on seasonal and secular trends best presented as line graphs
• Annual surveillance summaries should be produced nationally and regionally and fed back
• Annual overview helpful in trying to identify areas of concern and set priorities



• Monitor trends in disease incidence
• Monitor treatment guidelines
• Support essential drugs supply
• Detect peaks in incidence
• Identify high risk areas for further targeting intervention


Management of acute lower respiratory tract infections is part of the integrated case management approach to child health. The syndrome-based reporting approach is recommended as the most effective way to report on cases. However, this approach has not been proven from the perspective of surveillance of diseases: since multiple diagnoses are frequently made in children, the integrated case management approach may present difficulties for single disease surveillance.


Regional Offices

See Regional Communicable Disease contacts on section "Communicable disease contacts in Regional Offices".

Headquarters: 20 Avenue Appia, CH-1211 Geneva 27, Switzerland

Child and Adolescent Health and Development (CAH)


E-mail: robinsond@who.ch / Surveillancekit@who.ch
Tel: (41 22) 791 2969/2629/2111
Fax: (41 22) 791 4853
Website: http://cdrwww.who.ch
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