Pneumonia in Indigenous Children Territory-wide Using Radiological Endpoints (PICTURE)

The PICTURE Study (Pneumonia in Indigenous Children Territory-Wide Using Radiological Endpoints) documented the incidence of hospitalised, radiologically diagnosed pneumonia in Northern Territory Indigenous children aged less than five years over an eight year period from April 1997 to March 2005. All hospitalised episodes of care for any cause were reviewed and all chest radiographs (x-rays) taken during this time were assessed for severe pneumonia according to criteria developed by the World Health Organization. The study was designed to coincide with the introduction of the seven-valent pneumococcal conjugate vaccine in June 2001. This enabled a comparison of the burden of pneumonia before and after the vaccine was introduced. It is the largest and most systematic evaluation of the burden of pneumonia in Australia, and one of the largest in the world.

The burden of severe pneumonia:

• One-quarter of Indigenous children aged less than five years will be admitted each year with an acute lower respiratory tract infection.
• Approximately 3% of Indigenous children aged less than five years will be admitted at least once each year with an episode of x-ray confirmed pneumonia.
• The rates of x-ray confirmed pneumonia are now the highest reported in the world.

The impact of the 7-valent pneumococcal conjugate vaccine on severe pneumonia:

• The timeliness of 7-valent pneumococcal conjugate vaccine immunisation over the study period was poor, with only a third of infants having received the scheduled three doses by seven months of age.
• There was no change in the overall rates of x-ray confirmed pneumonia in Indigenous children aged less than five years in the post-vaccine era compared to the pre-vaccine era.

Key findings from the research highlight the importance of acute lower respiratory tract infections as major causes of morbidity in Indigenous children. The project has identified that little is known about what organisms are causing these infections, hampering the design of effective policy and interventions. Ongoing work aims to address this deficiency. Attention is now being paid to how best improve the timeliness of immunisation and to whether earlier schedules of existing or new pneumococcal and other respiratory vaccines may play a role in reducing disease burden.