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Pneumonia is the most common cause of death globally in children <5 years old, yet etiology is often undefined. In a case–control study in Bangladesh, The Gambia, Kenya, Mali, South Africa, Thailand, and Zambia, children aged 1 to 59 months hospitalized for pneumonia were enrolled. Controls were age-matched children from nearby communities. Multiple clinical specimens including nasopharyngeal, urine, blood, sputum, and pleural fluid were tested with cultures, 33-pathogen multiplex quantitative polymerase chain reaction, or both. Primary analyses were done only on children without HIV and included almost 1800 cases with abnormal chest x-rays and >5000 controls. Haemophilus influenzae type B vaccine was routinely used in most sites, pneumococ…