Hospital Admissions For Pneumonia Research Articles

Efficacy and safety of antimicrobial stewardship prospective audit and feedback in patients hospitalized with COVID-19: A protocol for a pragmatic clinical trial

The use of broad-spectrum antibiotics is widespread in patients with COVID-19 despite a low prevalence of bacterial co-infection, raising concerns for the accelerated development of antimicrobial resistance. Antimicrobial stewardship (AMS) is vital but there are limited randomized clinical trial data supporting AMS interventions such as prospective audit and feedback (PAF). High quality data to demonstrate safety and efficacy of AMS PAF in hospitalized COVID-19 patients are needed. This is a prospective, multi-center, non-inferiority, pragmatic randomized clinical trial evaluating AMS PAF intervention plus standard of care (SOC) versus SOC alone. We include patients with microbiologically confirmed SARS-CoV-2 infection requiring hospital admission for severe COVID-19 pneumonia. Eligible ward beds and critical care unit beds will be randomized prior to study commencement at each participating site by computer-generated allocation sequence stratified by intensive care unit versus conventional ward in a 1:1 fashion. PAF intervention consists of real time review of antibacterial prescriptions and immediate written and verbal feedback to attending teams, performed by site-based AMS teams comprised of an AMS pharmacist and physician. The primary outcome is clinical status at post-admission day 15 measured using a 7-point ordinal scale. Patients will be followed for secondary outcomes out to 30 days. A total of 530 patients are needed to show a statistically significant non-inferiority, with 80% power and 2.5% one-sided alpha assuming standard deviation of 2 and the non-inferiority margin of 0.5. This study protocol presents a pragmatic clinical trial design with small unit cluster randomization for AMS intervention in hospitalized COVID-19 that will provide high-level evidence and may be adopted in other clinical situations. This study is being performed at the University of Alberta and is registered at ClinicalTrials.gov (NCT04896866) on May 17, 2021.

Laboratory parameters associated with prolonged hospital length of stay in COVID-19 patients in Johannesburg, South Africa

Background. Coronavirus disease (COVID-19) has imposed unprecedented stressors on South Africa (SA)’s healthcare system. Superimposed on the country’s quadruple burden of disease, pandemic-related care further exposes existing inequities. Some of these inequities are specific to hospital-based inpatient services, such as the geographical maldistribution of hospital beds, lack of oxygen supplies and assisted ventilation, and scarcity of trained healthcare workers. Certain high-risk groups, such as individuals with cardiometabolic comorbidity, are likely to develop severe COVID-19 disease requiring hospitalisation with potential for a prolonged length of stay (LoS). It may be helpful for health authorities to identify those at risk for prolonged LoS to facilitate appropriate health systems planning. Objectives. To identify hospital admission laboratory parameters associated with a hospital stay >14 days in patients with COVID-19 pneumonia. Methods. A retrospective observational study design was used. Laboratory data were obtained from an SA private laboratory for 642 inpatients with suspected or confirmed COVID-19 pneumonia, comprising 7 months of admission laboratory data from six private hospitals in Johannesburg, Gauteng Province. Results. Of 642 hospital admissions for pneumonia, 497 were confirmed to have COVID-19 infection (reverse transcription-polymerase chain reaction test positive). In the COVID-19-positive group, hospital LoS was prolonged in 35.4% of admissions. Univariate analysis demonstrated an association with the following risk factors for prolonged LoS: older age; male sex; high serum creatinine, sodium (Na), chloride, potassium and urea levels and low estimated glomerular filtration rate; raised white blood cell count, lymphopenia, neutrophilia and an elevated neutrophil-to-lymphocyte ratio (NLR); and elevated levels of D-dimers, interleukin-6 (IL-6), and procalcitonin (PCT). The strongest univariate associations (relative risk (RR) ≥2.0) with a hospital stay >14 days were high Na levels, NRL >18, high PCT levels and IL-6 >40 pg/mL. On multivariable analysis, the following factors remained significantly associated with prolonged LoS: older age (RR 1.015 per year of age; 95% confidence interval (CI) 1.005 - 1.024); hypernatraemia (RR 1.80; 95% CI 1.25 - 2.60); hyperkalaemia (RR 1.61; 95% CI 1.18 - 2.20); and neutrophilia (RR 1.47; 95% CI 1.15 - 1.88). Conclusions. COVID-19 pandemic preparedness requires hospital-based inpatient care to be prioritised in resource-limited settings, and availability of beds and prompt admissions are essential to ensure good clinical outcomes. In this study of COVID-19 patients admitted with pneumonia, multivariable analysis showed older age, hypernatraemia, hyperkalaemia and neutrophilia to be associated with LoS >14 days. This may assist with healthcare systems planning.

Development and validation of SCOPE score: A clinical score to predict COVID-19 pneumonia progression to severe respiratory failure

SummaryMost patients infected with SARS-CoV-2 (COVID-19) experience mild, non-specific symptoms, but many develop severe symptoms associated with an excessive inflammatory response. Elevated plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) provide early warning of progression to severe respiratory failure (SRF) or death, but access to suPAR testing may be limited. The Severe COvid Prediction Estimate (SCOPE) score, derived from circulating concentrations of C-reactive protein, D- dimers, interleukin-6, and ferritin among patients not receiving non-invasive or invasive mechanical ventilation during the SAVE-MORE study, offers predictive accuracy for progression to SRF or death within 14 days comparable to that of a suPAR concentration of ≥6 ng/mL (area under receiver operator characteristic curve 0.81 for both). The SCOPE score is validated in two similar independent cohorts. A SCOPE score of 6 or more is an alternative to suPAR for predicting progression to SRF or death within 14 days of hospital admission for pneumonia, and it can be used to guide treatment decisions.

Influence of temperature and relative humidity on hospital admissions due to pneumonia: a study in the South and Southeast regions of Brazil

This study aims to evaluate the influence of meteorological factors on hospital admissions for pneumonia in children and elderly in Bauru and Pelotas cities, between 2009 to 2016. The health information was obtained from the Brazilian System Database and the daily average temperature and relative humidity from the meteorological stations of the National Institute of Meteorology and of the UNESP Meteorological Center. Descriptive analyses were performed to verify temporal trends and seasonal variations of meteorological variables and hospitalizations. Spearman correlation and Generalized Additive Model (GAM) Statistical methods were applied too. The results showed that Pelotas, presents the highest frequency of hospitalizations. It’s observed an increase in admissions in winter in both cities, except for children, in Bauru/SP, which occurs more frequently in the fall. The correlation was significant for low air temperature and high relative humidity. In addition, the GAM indicated a higher risk of hospitalizations with temperatures below 16°C and relative humidity above 40% (Bauru) and 80% in Pelotas. The increase in hospitalizations occurs in winter, and caused by the low temperatures and high relative humidity.

Causes and timing of 30-day rehospitalization from skilled nursing facilities after a hospital admission for pneumonia or sepsis.

BackgroundPneumonia and sepsis are among the most common causes of hospitalization in the United States and often result in discharges to a skilled nursing facility (SNF) for rehabilitation. We described the timing and most common causes of 30-day unplanned hospital readmission following an index hospitalization for pneumonia or sepsis.Methods and findingsThis national retrospective cohort study included adults ≥65 years who were hospitalized for pneumonia or sepsis and were discharged to a SNF between July 1, 2012 and July 4, 2015. We quantified the ten most common 30-day unplanned readmission diagnoses and estimated the daily risk of first unplanned rehospitalization for four causes of readmission (circulatory, infectious, respiratory, and genitourinary). The index hospitalization was pneumonia for 92,153 SNF stays and sepsis for 452,254 SNF stays. Of these SNF stays, 20.9% and 25.9%, respectively, resulted in a 30-day unplanned readmission. Overall, septicemia was the single most common readmission diagnosis for residents with an index hospitalization for pneumonia (16.7% of 30-day readmissions) and sepsis (22.4% of 30-day readmissions). The mean time to unplanned readmission was approximately 14 days overall. Respiratory causes displayed the highest daily risk of rehospitalization following index hospitalizations for pneumonia, while circulatory and infectious causes had the highest daily risk of rehospitalization following index hospitalizations for sepsis. The day of highest risk for readmission occurred within two weeks of the index hospitalization discharge, but the readmission risk persisted across the 30-day follow-up.ConclusionAmong older adults discharged to SNFs following a hospitalization for pneumonia or sepsis, hospital readmissions for infectious, circulatory, respiratory, and genitourinary causes occurred frequently throughout the 30-day post-discharge period. Our data suggests further study is needed, perhaps on the value of closer monitoring in SNFs post-hospital discharge and improved communication between hospitals and SNFs, to reduce the risk of potentially preventable hospital readmissions.

From Chest Wall Resection to Medical Management: The Continued Saga of Parapneumonic Effusion Management and Future Directions.

Pleural space infections have been described since the time of Hippocrates and to this day remains a significant pathology. Every year in the USA approximately there are one million hospital admissions for pneumonia with 20%-40% associated with some form of pleural space infections leading to pleural effusions with increased morbidity and mortality. Often, management of these effusions mandate combination of medical treatment and surgical drainage with debridement and decortication. There has been a lot of ongoing research regarding the safety and efficacy of intrapleural fibrinolytics in the management of complicated pleural effusions and empyema. Till this day, areas of debate and controversies exist among clinicians treating pleural space infection. Empyema is historically considered a surgical disease. There have been societies and guidelines for the management of infected parapneumonic effusions with antibiotics and chest tube drainage as an initial empiric treatment modality. With the advances in the use of Intrapleural fibrinolytics and minimally invasive procedures such as video-assisted thoracoscopic surgery (VATS), empyema a surgical disease is now more favoring medical management. Surgical option, such as open thoracotomy, is reserved for patients who failed conservative management and chronic empyema. The aim of this comprehensive review is to shed light on the evolution of various management strategies from the era of Hippocrates to current day practice and how there continues to be a paradigm shift in treating empyema as a surgical condition to a medical disease.

Associations of air pollutants with pneumonia hospital admissions in Qingdao, China: a prospective cohort study.

Studies about the pneumonia morbidity effects of various air pollution exposure are still limited in China. We aimed to explore the short-term effect of air pollutants exposure on pneumonia admission and identify the vulnerable groups in Qingdao, China. From January 2015 to October 2017, a prospective cohort involving 433,032 participants across 3 counties in Qingdao were enrolled in the study. Distributed lag nonlinear model (DLNM) was applied to assess the associations between air pollutants and pneumonia hospitalizations. There were 636 cases of pneumonia, with an annual incidence density of 54.33 per 100,000 person-years (95% CI: 50.11, 58.56). A 10μg/m3 increment of sulfur dioxide (SO2) distributed at a 4-week lag in Qingdao was associated with increased pneumonia hospitalizations, with a risk ratio of 2.10 (95% CI: 1.06, 4.13). Subgroup analyses indicate that PM ≤ 2.5μm in aerodynamic diameter and SO2 showed stronger effects on pneumonia in females than males, whereas people in urban regions were more vulnerable to nitrogen dioxide and ozone (O3) than the others. We also observed distinct acute effects and harvesting effects of SO2 and O3 on pneumonia in urban areas. Strategies should be taken to further reduce levels of ambient PM2.5, SO2, and O3.

Analysis of four cases with congenital pulmonary airway malformation complicated by chronic pulmonary aspergillosis

Objective: To investigate the clinical characteristics, treatment and prognosis of congenital pulmonary airway malformation (CPAM) complicated with chronic pulmonary aspergillosis (CPA) in children. Methods: The clinical manifestation, laboratory test, radiological feature, treatment and prognosis of 4 pediatric patients diagnosis of CPAM with CPA ascertained between March 2016 and April 2020 at the Department of No.2 Respiratory Medicine and Thoracic Surgery of Beijing Children's Hospital were retrospectively analyzed. Results: The 4 children included 2 males and 2 females, their age ranged from 9.9 to 13.6 years. Cough presented in 3 cases, hemoptysis in 2 cases, whereas in 1 case, pneumothorax was the first manifestation of the condition. Past history revealed multiple hospital admissions for pneumonia in 2 children and 1 with more than 2 episodes of wheezing. Aspergillus IgG was positive in 3 patients. Significantly elevated total IgE and fumigatus-specific IgE levels were noted in 2 children. CT demonstrated multiple cystic lesions, and fungal balls were seen in 2 children. They all underwent lobectomy and the lung tissue from the 4 children all demonstrated CPAM with Aspergillus infection. Aspergillus fumigatus was isolated from the abscess collected during operation in 1 patient. Postoperative, voriconazole was given in 3 children for 8 weeks, recurrence was observed in 2 children with characteristics of allergic bronchopulmonary aspergillosis. Voriconazole was given in one patient for 12 weeks with no recurrence. Conclusions: CPAM might be complicated with CPA,if there are hemoptysis, and fungal ball in chest CT, cautious preoperative examinations for microorganism are necessary. The necessity and duration of postoperative antifungal therapy need to be determined on individual basis.

PREVALENCE OF INTERSTITIAL LUNG ABNORMALITIES AND ASSOCIATION WITH MORTALITY AND HOSPITALIZATION IN A CT LUNG CANCER SCREENING COHORT

TOPIC: Diffuse Lung Disease TYPE: Original Investigations PURPOSE: Interstitial lung abnormalities (ILA), non-dependent interstitial changes identified on lung CT scans, have been shown to have significant biological and clinical consequences. In some cases, ILA may represent a less severe or earlier stage of pulmonary fibrosis. In the United States, 14.5 million patients are estimated to be eligible for CT lung cancer screening (CTLS) which has the potential to be an early screening tool for interstitial lung disease. In this study, we sought to characterize ILA in a large CTLS cohort, evaluating prevalence and associations with clinically relevant outcomes. METHODS: Patients (n=1703) from Lahey Hospital and Medical Center who underwent CTLS from Jan 12, 2012 through Sep 30, 2014 and had an in network primary care physician were included; outcomes data was collected through Sep 30, 2019. Two thoracic radiologists certified in lung cancer screening scored the baseline CT exams per Fleischner Society ILA position paper guidelines (ILA, indeterminate, no ILA). For CT scans in which the score was discordant between the two radiologists (n=163), a third reader scored the CT to determine the final score. Cox multivariable regression proportional hazards models were used to test the association between ILA and cancer, all-cause mortality, all cause hospitalization and COPD and pneumonia related hospital admission adjusted for age, sex, smoking status and pack years exposure. Kaplan-Meier plots were generated to visualize the associations between observed baseline ILA and clinical outcomes. To adjust for multiplicity Bonferroni correction was utilized and p-value significance was set at<=0.01. All statistical analyses were performed using STATA14.1. RESULTS: Baseline characteristics were mean age 62.6 ± 6.2 years, 56.3% male, 57.7% with emphysema. A total of 101 (5.9%) patients were scored indeterminate and 45 (2.6%) were scored for ILA on the baseline CT. Of those with ILA, 35 (78%) had not been seen by a pulmonologist prior to their baseline CT and average time between baseline CTLS exam and referral was 2.51 ± 2.85 years. Of the patients with baseline ILA, who did not carry a pre-scan diagnosis of interstitial lung disease (ILD) (n=39), 15(33.3%) subsequently received a clinical diagnosis of ILD, 5.0 ± 2.5 years post baseline scan. In multivariable modeling, the presence of ILA was associated with death, HR 4.05 (2.26, 7.23, p<0.001) and hospital admission for pneumonia, HR 3.07 (1.41, 6.68, p<0.005). CONCLUSIONS: The results of this study demonstrate that ILA are a significant clinical finding in a large CTLS cohort with a prevalence and 5-year mortality risk similar to that of lung cancer. A significant percentage of these patients develop clinical ILD and may benefit from early pulmonology referral, evaluation, and management. CLINICAL IMPLICATIONS: Identification of ILA in a CTLS cohort has the potential to identify patients who will develop clinical ILD. DISCLOSURES: No relevant relationships by Melissa Gawlik, source=Web Response Grant funding relationship with Genentech Please note: 9/10/2020 Added 04/23/2021 by Lee Gazourian, source=Web Response, value=Grant/Research Support No relevant relationships by Jeffrey Hashim, source=Web Response No relevant relationships by Gary Hunninghake, source=Web Response Advisor relationship with AstraZeneca Please note: 2019-2021 Added 04/22/2021 by Brady McKee, source=Web Response, value=Advisor Fee No relevant relationships by Timothy MD, source=Web Response No relevant relationships by Ezra Miller, source=Web Response Grant recipient relationship with Genentech Please note: 07/01/2020 -- Added 04/18/2021 by Avignat Patel, source=Web Response, value=Grant/Research Support No relevant relationships by Lori Lyn Price, source=Web Response No relevant relationships by Shawn Regis, source=Web Response No relevant relationships by Christoph Wald, source=Web Response, value=Honoraria Removed 04/22/2021 by Christoph Wald, source=Web Response

Ambient PM2.5 and PM10 Exposure and Respiratory Disease Hospitalization in Kandy, Sri Lanka.

Evidence of associations between exposure to ambient air pollution and health outcomes are sparse in the South Asian region due to limited air pollution exposure and quality health data. This study investigated the potential impacts of ambient particulate matter (PM) on respiratory disease hospitalization in Kandy, Sri Lanka for the year 2019. The Generalized Additive Model (GAM) was applied to estimate the short-term effect of ambient PM on respiratory disease hospitalization. As the second analysis, respiratory disease hospitalizations during two distinct air pollution periods were analyzed. Each 10 μg/m3 increase in same-day exposure to PM2.5 and PM10 was associated with an increased risk of respiratory disease hospitalization by 1.95% (0.25, 3.67) and 1.63% (0.16, 3.12), respectively. The effect of PM2.5 or PM10 on asthma hospitalizations were 4.67% (1.23, 8.23) and 4.04% (1.06, 7.11), respectively (p < 0.05). The 65+ years age group had a higher risk associated with PM2.5 and PM10 exposure and hospital admissions for all respiratory diseases on the same day (2.74% and 2.28%, respectively). Compared to the lower ambient air pollution period, higher increased hospital admissions were observed among those aged above 65 years, males, and COPD and pneumonia hospital admissions during the high ambient air pollution period. Active efforts are crucial to improve ambient air quality in this region to reduce the health effects.

Impact of nonpharmacological COVID-19 interventions in hospitalizations for childhood pneumonia in Brazil.

The knowledge about the impact of the nonpharmacological measures to control the COVID-19 pandemic can give insight into ways in which they can also be applied for other respiratory diseases. To assess the impact of containment measures of the COVID-19 pandemic on pneumonia hospitalizations in children from 0 to 14 years of age in Brazil. Data from hospital admissions for pneumonia were obtained from the Department of Informatics of Brazilian Public Health System database in the period of 2015-2020 and analyzed by macroregions and age groups. To evaluate the effect of containment measures, on the incidence of pneumonia, the absolute reduction and relative reduction were calculated by analyzing the subsets 2015-2019 vs. 2020. Comparing the subsets of April-August 2015-2019 vs. April-August 2020 for Brazil (total), there was an significant reduction in the average incidence of hospitalizations, with numbers ranging from -82% [IRR 0.17 (0.14-0.21)] for <4 years (prepandemic 741.8/100,000 vs. pandemic 132.7/100.000), -83% [IRR 0.17 (0.10-0.27)] for 5-9 years (prepandemic 113.6/100,000 vs. pandemic 19.6/100.000), -77% [IRR 0.23 (0.11-0.46)] for 10-14 (prepandemic 42.0/100,000 vs. pandemic 9.8/100.000) and -82% [IRR 0.18 (0.15-0.21)] for all children ≤14 years (prepandemic 897.4/100,000 vs. pandemic 162.1/100.000). We found a significant decrease in cases of all cause pneumonia in children under 14 years and especially in the age group <9 years during the COVID-19 pandemic, which may be associated with the nonpharmacological measures applied to control the SARS-CoV-2.

Qualitative coronary artery calcification scores and risk of all cause, COPD and pneumonia hospital admission in a large CT lung cancer screening cohort

BackgroundPatients at high-risk for lung cancer and qualified for CT lung cancer screening (CTLS) are at risk for numerous cardio-pulmonary comorbidities. We sought to examine if qualitatively assessed coronary artery calcifications (CAC) on CTLS exams could identify patients at increased risk for non-cardiovascular events such as all cause, COPD and pneumonia related hospitalization and to verify previously reported associations between CAC and mortality and cardiovascular events. Study design and methodsPatients (n = 4673) from Lahey Hospital and Medical Center who underwent CTLS from January 12, 2012 through September 30, 2017 were included with clinical follow-up through September 30, 2019. CTLS exams were qualitatively scored for the presence and severity of CAC at the time of exam interpretation using a four point scale: none, mild, moderate, and marked. Multivariable Cox regression models were used to evaluate the association between CT qualitative CAC and all-cause, COPD-related, and pneumonia-related hospital admissions. Results3631 (78%) of individuals undergoing CTLS had some degree of CAC on their baseline exam: 1308 (28.0%), 1128 (24.1%), and 1195 (25.6%) had mild, moderate and marked coronary calcification, respectively. Marked CAC was associated with all-cause hospital admission and pneumonia related admissions HR 1.48; 95% CI 1.23–1.78 and HR 2.19; 95% 1.30–3.71, respectively. Mild, moderate and marked CAC were associated with COPD-related admission HR 2.30; 95% CI 1.31–4.03, HR 2.17; 95% CI 1.20–3.91 and HR 2.27; 95% CI 1.24–4.15. ConclusionQualitative CAC on CTLS exams identifies individuals at elevated risk for all cause, pneumonia and COPD-related hospital admissions.

Statistical modeling of hospital admissions for pneumonia in Campo Grande

Justification and Objectives: Brazil lacks consistent epidemiological data on the respiratory morbidity of children and older adults, which makes it difficult to plan and execute effective preventive and health promotion actions. The objective of this study was to analyze the adjustments of distributions (Weibull, Normal, Gamma, Logistic) of historical series of hospitalizations for respiratory diseases (total hospitalizations), from 2011 to 2015, in Campo Grande, Mato Grosso do Sul. Methods: to determine the statistical models, four statistical indicators (coefficient of determination, mean root square error, mean absolute error and mean absolute percentage error) were performed from 2011 to 2015. Parameter estimates are obtained for the models adopted in the study, with and without a regression structure. Results: the results showed that Weibull, Gamma, Normal and Logistic distributions, applied to the series of hospitalizations for respiratory diseases in Campo Grande, were satisfactory in determining the shape and scale parameters, and the statistical indicators R2, MAE, RSME and MAPE confirmed the data goodness-of-fit, and the graphical analysis indicated a satisfactory distribution fit. Conclusion: the analysis of monthly values indicates that Gamma is the best of the four distributions based on those selected. The regression model can be adjusted to the data and used as an alternative distribution that describes the hospitalization data considered in Campo Grande, Brazil.

Lagged Association between Climate Variables and Hospital Admissions for Pneumonia in South Africa.

Pneumonia is a leading cause of hospitalization in South Africa. Climate change could potentially affect its incidence via changes in meteorological conditions. We investigated the delayed effects of temperature and relative humidity on pneumonia hospital admissions at two large public hospitals in Limpopo province, South Africa. Using 4062 pneumonia hospital admission records from 2007 to 2015, a time-varying distributed lag non-linear model was used to estimate temperature-lag and relative humidity-lag pneumonia relationships. Mean temperature, relative humidity and diurnal temperature range were all significantly associated with pneumonia admissions. Cumulatively across the 21-day period, higher mean daily temperature (30 °C relative to 21 °C) was most strongly associated with a decreased rate of hospital admissions (relative rate ratios (RR): 0.34, 95% confidence interval (CI): 0.14–0.82), whereas results were suggestive of lower mean daily temperature (12 °C relative to 21 °C) being associated with an increased rate of admissions (RR: 1.27, 95%CI: 0.75–2.16). Higher relative humidity (>80%) was associated with fewer hospital admissions while low relative humidity (<30%) was associated with increased admissions. A proportion of pneumonia admissions were attributable to changes in meteorological variables, and our results indicate that even small shifts in their distributions (e.g., due to climate change) could lead to substantial changes in their burden. These findings can inform a better understanding of the health implications of climate change and the burden of hospital admissions for pneumonia now and in the future.

Exploring rural hospital admissions for diarrhoeal disease, malaria, pneumonia, and asthma in relation to temperature, rainfall and air pollution using wavelet transform analysis

BackgroundClimate variables impact human health and in an era of climate change, there is a pressing need to understand these relationships to best inform how such impacts are likely to change. ObjectivesThis study sought to investigate time series of daily admissions from two public hospitals in Limpopo province in South Africa with climate variability and air quality. MethodsWe used wavelet transform cross-correlation analysis to monitor coincidences in changes of meteorological (temperature and rainfall) and air quality (concentrations of PM2.5 and NO2) variables with admissions to hospitals for gastrointestinal illnesses including diarrhoea, pneumonia-related diagnosis, malaria and asthma cases. We were interested to disentangle meteorological or environmental variables that might be associated with underlying temporal variations of disease prevalence measured through visits to hospitals. ResultsWe found preconditioning of prevalence of pneumonia by changes in air quality and showed that malaria in South Africa is a multivariate event, initiated by co-occurrence of heat and rainfall. We provided new statistical estimates of time delays between the change of weather or air pollution and increase of hospital admissions for pneumonia and malaria that are addition to already known seasonal variations. We found that increase of prevalence of pneumonia follows changes in air quality after a time period of 10 to 15 days, while the increase of incidence of malaria follows the co-occurrence of high temperature and rainfall after a 30-day interval. DiscussionOur findings have relevance for early warning system development and climate change adaptation planning to protect human health and well-being.

Association of ambient ozone with pneumonia hospital admissions in Hong Kong and Taipei: A tale of two Southeast Asian cities.

Ozone (O3) is a reactive oxidant exerting both inflammatory and oxidative damages to the respiratory system. With the ground-level O3 progressively increasing in the past decade, the reevaluation of the pneumonia hospitalization risk from exposure to O3 is of public health interest. We conducted an ecological time-series study to examine the city-specific association between short-term O3 exposure and pneumonia hospitalizations in Hong Kong and Taipei, respectively. We linked the daily pneumonia hospitalization count to air pollution concentrations and weather conditions according to the date of admission during 2010-2017. We applied a generalized additive distributed lag model to examine the association while adjusting for time-varying covariates. Stratified analysis by age group and the potential harvesting effect of O3 were evaluated. We observed the harvesting effects of O3 on pneumonia hospitalizations in children in both cities and adults in Taipei. The short-term effect of O3 lasted for around one week. An interquartile range (IQR) increment of daytime 8-hour mean concentration of O3 distributed over 0-6 lag days in Hong Kong (42.4μg/m3) was associated with a 7.04% (95% CI: 5.35-8.76%) increase in hospital admissions for elderly pneumonia, while the corresponding cumulative excess risk per IQR increment of O3 in Taipei (38.7μg/m3) was 3.41% (95% CI: 1.63-5.22%). Different O3 metrics, varying degrees of freedom for filtering the temporal trend, and three-pollutant models supported the robustness of the associations. We concluded that short-term O3 exposure was associated with pneumonia hospitalizations in the elderly population. Understanding the pneumonia hospitalization risk of O3 will help to inform public health policies in the planning of ozone control strategies and intervention measures to prevent ozone-related pneumonia in vulnerable elderly populations.

Impact of Pandemic Nonpharmacological Public Health Interventions in Response to COVID-19 on Hospitalizations for Pneumonia in Children in Brazil

Background: The knowledge about the impact of the nonpharmacological measures to control the COVID-19 pandemic can give insight to ways in which they can also be applied for other respiratory diseases and therefore possibly help to reduce the burden of respiratory conditions in health systems. To assess the impact of containment measures of the COVID-19 pandemic on pneumonia hospitalizations in children from 0 to 14 years of age in Brazil. &amp;nbsp; Methods: Data from hospital admissions for pneumonia were obtained from the Department of Informatics of Brazilian Public Health System database in the period of 2015&ndash;2020 and analyzed by macro-regions and age groups. To evaluate the effect of containment measures, used in the pandemic, on the incidence of pneumonia, the absolute reduction (without - with pandemic containment measures) and relative reduction (without - with pandemic containment measures / without pandemic containment measures) were calculated by analyzing the subsets 2015-2019 vs 2020. &amp;nbsp; Findings: Comparing the subsets of April-August 2015-2019 vs April-August 2020, there was an expressive reduction in the average incidence of hospitalizations, with numbers ranging from -87% [IRR 0.12 (0.10 to 0.14)] for &amp;lt; 4 years, -79% [IRR 0.21 (0.07 to 0.57)] for 5-9 years, -73% [IRR 0.26 (0.05 to 1.21)] for 10-14 and -86% [IRR 0.14 (0.06 to 0.29)] for&amp;nbsp; &amp;lt;14 years. When comparing the subsets by macro-regions of Brazil (April-August 2015-2019 vs April-August 2020), a drop in hospitalizations was observed which ranged from -77% [IRR 0.23 (0.15 to 0.34)] in the Southeast to -87% [IRR 0.12 (0.07 to 0.21)] in the Northeast in children under 4 years. For children 5-9 years the fall ranged from -69% [IRR 0.30 (0.11 to 0.79)] in the Southeast region to -90% [IRR 0.10 (0.02 to 0.38)] in the South and in children 10-14 years, hospitalizations ranged from -73% [IRR 0.26 (0.05 to 1.21)] to -89% [IRR 0.19 (0.03 to 0.98)] in the South. &amp;nbsp; Interpretation: We found a significant decrease in cases of pneumonia during the COVID-19 pandemic. Nonpharmacological public health interventions can contribute to the decline of other respiratory infectious diseases. Funding: The present work was carried out with the support of the Coordination of Improvement of Personnel Higher Education - Brazil (CAPES) - Financing Code 001. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript. Declaration of Interest: None to declare.

Development and Validation of SCOPE Score: A Clinical Score to Predict Progression to Severe Respiratory Failure in Hospitalized Patients With COVID-19 Pneumonia

Most patients infected with SARS-CoV-2 (COVID-19) experience mild, non-specific symptoms, but several develop severe symptoms associated with an excessive inflammatory response. Elevated plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) provide early warning of progression to severe respiratory failure (SRF) or death, but access to suPAR testing may be limited. The Severe COvid Prediction Estimate (SCOPE) score, derived from C-reactive protein, D-dimer, interleukin-6, and ferritin circulating concentrations at hospitalization during the SAVE-MORE study, offers comparable predictive accuracy for progression to SRF or death within 14 days as suPAR ≥6 ng/ml (area under receiver operator characteristic curve, 0.81 for both). SCOPE score was validated against an independent dataset from the SAVE study. The SCOPE score is an alternative to suPAR for predicting progression to SRF or death within 14 days of hospital admission for pneumonia, and it can be used to guide treatment decisions.Funding: The study was funded in part by the Hellenic Institute for the Study of Sepsis and by Swedish Orphan Biovitrum. The Hellenic Institute for the Study of Sepsis is the Sponsor of the SAVE and SAVE-MORE studies.Declaration of Interests:E. J. Giamarellos-Bourboulis has received honoraria from Abbott CH, bioMérieux, Brahms GmbH, GSK, InflaRx GmbH, Sobi and XBiotech Inc; independent educational grants from Abbott CH, AxisShield, bioMérieux Inc, InflaRx GmbH, Johnson & Johnson, MSD, Sobi and XBiotech Inc.; and funding from the Horizon2020 Marie-Curie Project European Sepsis Academy (granted to the National and Kapodistrian University of Athens), and the Horizon 2020 European Grants ImmunoSep and RISKinCOVID (granted to the Hellenic Institute for the Study of Sepsis). G. Poulakou has received independent educational grants from Pfizer, MSD, Angelini, and Biorad. H. Milionis reports receiving honoraria, consulting fees and non-financial support from healthcare companies, including Amgen, Angelini, Bayer, Mylan, MSD, Pfizer, and Servier. L. Dagna had received consultation honoraria from SOBI. M. Bassetti has received funds for research grants and/or advisor/consultant and/or speaker/chairman from Angelini, Astellas, Bayer, Biomerieux, Cidara, Cipla, Gilead, Menarini, MSD, Pfizer, Roche, Shionogi and Nabriva. P. Panagopoulos has received honoraria from GILEAD Sciences, Janssen, and MSD. G. N. Dalekos is an advisor or lecturer for Ipsen, Pfizer, Genkyotex, Novartis, Sobi, received research grants from Abbvie, Gilead and has served as PI in studies for Abbvie, Novartis, Gilead, Novo Nordisk, Genkyotex, Regulus Therapeutics Inc, Tiziana Life Sciences, Bayer, Astellas, Pfizer, Amyndas Pharmaceuticals, CymaBay Therapeutics Inc., Sobi and Intercept Pharmaceuticals. M. G. Netea is supported by an ERC Advanced Grant (#833247) and a Spinoza grant of the Netherlands Organization for Scientific Research. Hes is a scientific founder of TTxD and he has received independent educational grants from TTxD, GSK, Ono Pharma and ViiV HealthCare. The other authors do not have any competing interest to declare.Ethics Approval Statement: The SAVE protocol was approved by the National Ethics Committee of Greece (approval 38/20) and National Organization for Medicines approval (ISO 28/20). The SAVE-MORE protocol was approved by the National Ethics Committee of Greece (approval 161/20) and by the Ethics Committee of the National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, in Rome (1 February 2021).Trial Registration: The SAVE study was prospectively registered prior to enrolling the first patient (EudraCT number 2020-001466-11; ClinicalTrials.gov identifier NCT04357366). The SAVE-MORE study was prospectively registered (EudraCT no. 2020-005828-11; ClinicalTrials.gov identifier NCT04680949). Written informed consent was provided by all patients prior to enrollment.

1397. Long term impact of the 13-valent pneumococcal conjugate vaccine use in infant immunization program on all-cause pneumonia hospitalizations in British Columbia, Canada: a time series analysis

BackgroundPneumonia is a leading cause of hospitalization and in-patient mortality globally. We determined the impact of 13-valent pneumococcal conjugate vaccine (PCV13) use on all-cause pneumonia hospitalization rates eight years after the vaccine was introduced in British Columbia, Canada.MethodsRoutine administrative databases, such as, hospital discharge abstract databases, registry and demographics were used to build the cohort. Overall and age-specific all-cause pneumonia hospital admissions per month (Jan 2000 to Dec 2018) for those aged < 2 years, 2-5 years, 6-17 years, 18-64 years and ≥ 65 years were obtained using International Classification of Diseases 9 and 10 codes (480-486, J12-J18). Changes in the all-cause pneumonia hospitalization incidence rates before and after the PCV13 vaccine program introduction were evaluated using a negative binomial regression and time-series modelling while adjusting for seasonality, influenza-likeness illnesses, 7-valent pneumococcal conjugate vaccine (PCV7) program and pre-PCV13 vaccine secular trends.ResultsLong term use of the PCV13 vaccine in the infant immunization program was associated with significant declines in all-cause pneumonia hospitalization rates among all children, < 2 years (IRR: 0.63; 95% Confidence Interval (CI): 0.59-0.67), 2-5 years (IRR: 0.82; 95%CI: 0.77-0.87) and 6-17 years (IRR: 0.73; 95%CI: 0.69-0.78). All-cause pneumonia rates did not change significantly in those aged 18-64 years (IRR: 0.98; 95%CI: 0.96-1), whereas a modest increase was observed in those 65 years and over (IRR: 1.05; 95%CI: 1.02-1.07). Consequently, we did not observe significant change in the overall rate (IRR: 1.02; 95%CI: 1-1.02).ConclusionSignificant reduction in all-cause pneumonia hospitalization rates in children demonstrates long term beneficial effect of PCV13 use. A modest increase in all-cause pneumonia hospitalization rates in adults aged 65 years and over indicates a need for further microbial investigation.DisclosuresNirma Khatri Vadlamudi, BA, BS, MPH, Pfizer Inc (Research Grant or Support) Fawziah Marra, BSc (Pharm), PharmD, Pfizer Inc (Research Grant or Support)

Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumonia hospital admissions in Fiji: a time-series analysis

In October, 2012, Fiji introduced routine infant immunisation with a ten-valent pneumococcal conjugate vaccine (PCV10) using three primary doses and no booster dose (3 + 0 schedule). Data are scarce for the effect of PCV in the Asia and Pacific region. We aimed to evaluate the effect of PCV10 on pneumonia hospital admissions in children younger than 5 years and adults aged 55 years and older in Fiji, 5 years after vaccine introduction. We did a time-series analysis assessing changes in pneumonia hospital admissions at three public tertiary hospitals in Fiji. Four pneumonia outcomes were evaluated: all-cause pneumonia, severe or very severe pneumonia, hypoxic pneumonia, and radiological pneumonia. Participants aged younger than 2 months, 2-23 months, 24-59 months, and 55 years and older were included. Data were extracted from the national hospital admission database according to International Classification of Diseases-tenth revision codes J10·0-18·9, J21, and J22 for all-cause pneumonia. Medical records and chest radiographs were reviewed for the main tertiary hospital to reclassify hospital admissions in children aged younger than 2 years as severe or very severe, hypoxic, or radiological pneumonia as per WHO definitions. Time-series analyses were done using the synthetic control method and multiple imputation to adjust for changes in hospital usage and missing data. Between Jan 1, 2007, and Dec 31, 2017, the ratio of observed cases to expected cases for all-cause pneumonia was 0·92 (95% CI 0·70-1·36) for children aged younger than 2 months, 0·86 (0·74-1·00) for children aged 2-23 months, 0·74 (0·62-0·87) for children aged 24-59 months, and 1·90 (1·53-2·31) in adults aged 55 years and older, 5 years after PCV10 introduction. These findings indicate a reduction in all-cause pneumonia among children aged 24-59 months and an increase in adults aged 55 years and older, but no change among children aged younger than 2 months. Among children aged 2-23 months, we observed declines of 21% (95% CI 5-35) for severe or very severe pneumonia, 46% (33-56) for hypoxic pneumonia, and 25% (9-38) for radiological pneumonia. Mortality reduced by 39% (95% CI 5-62) for all-cause pneumonia, bronchiolitis, and asthma admissions in children aged 2-23 months. The introduction of PCV10 was associated with a decrease in pneumonia hospital admissions in children aged 2-59 months. This is the first study in a middle-income country in the Asia and Pacific region to show the effect of PCV on pneumonia, filling gaps in the literature on the effects of PCV10 and 3 + 0 schedules. These data support decision making on PCV introduction for other low-income and middle-income countries in the region. Department of Foreign Affairs and Trade of the Australian Government.