In Reply: Drs Nascimento-Carvalho and Ruuskanen raise several interesting and informative points. The WHO clinical syndromes of severe pneumonia and very severe pneumonia capture forms of lower respiratory tract infection that are severe enough to result in lower chest wall indrawing (or worse) and hospitalization. They are clinically recognizable syndromes, rather than pathological diagnoses, aimed at sensitivity in identifying children who require antibiotics, are hypoxemic, or are likely to die.1 From an epidemiological standpoint, the syndromes serve to define the burden of severe and life-threatening lower respiratory tract infection.
Berkley JA, Munywoki P, Nokes DJ. Severe Pneumonia Among Kenyan Infants and Children—Reply. JAMA. 2010;304(9):963-965. doi:10.1001/jama.2010.1244