Incidence Of Community-acquired Pneumonia Research Articles

CLINICAL CASES OF LEGIONELLIosis IN THE KRASNODAR REGION DURING THE NEW CORONAVIRUS INFECTION COVID-19 PANDEMIC, DIFFICULTIES IN DIAGNOSIS

The high incidence of community-acquired pneumonia against the backdrop of continued registration of COVID-19 requires early differential diagnosis, due to different patient management tactics. Among community-acquired pneumonias, legionella diseases deserve special attention. The difficulty of clinical diagnosis of legionellosis during the COVID-19 pandemic leads to untimely prescription of specific antibacterial therapy, which worsens the prognosis of the outcome of the disease. The work provides clinical examples that draw the attention of specialists to the features of clinical, laboratory and radiological manifestations of legionellosis, as well as the important role of epidemiological data for the differential diagnosis of legionellosis from the new coronavirus infection COVID-19.

IJCM_103A: Cost Benefit Analysis Related to Community Acquired Pneumonia inpatients among Geriatric Age Group-A Study Conducted in A Tertiary Care Hospital

Background: Community-acquired pneumonia (CAP) is a common acute infectious disease among elderly people, and is associated with high rates of hospital admission and mortality. Old Age and male sex are known risk factors for CAP among adults and many comorbidity are also risk factors for CAP, such as chronic obstructive pulmonary disease (COPD), diabetes, cancer, dementia, congestive heart failure, and liver function failure. Objective: This study aimed to estimate the economic burden of community- acquired pneumonia (CAP) among elderly patients in Berhampur, Odisha. In addition, the study evaluated the relationship between total treatment cost and CAP risk factors. Methodology: A cross-sectional study was conducted in the IPD of MKCG MKCG Medical College of Berhampur in the period of September-November 2023. Purposive sampling was used and data was collected using semi structured questionnaire and analyzed by MS Excel 2017 Results: Among 348 are inpatient CAP episodes the mean ages were 63±8 years in outpatient group and 70±4 yrs in inpatient groups respectively. The Median treatment cost is Rs.3000/-INR per outpatient episode and Rs 10060/-INR per inpatient episode.Old patient, Male sex, Diabetes, Chronic obstructive Pulmonary Disease, liver dysfunction were associated with increased treatment cost. Conclusion: The economic burden of CAP might be decreased by reducing the number of hospitalizations for mild CAP and the incidence of severe CAP. Therefore, preventative care (e.g. oral hygiene or pneumococcus vaccination) is recommended for patients with related risk factors, such as male sex, older age, diabetes, chronic obstructive pulmonary disease.

Effect of vaccination on morbidity and mortality from community-acquired pneumonia

Background. Community-acquired pneumonia remains one of the most common and life-threatening forms of pathology among respiratory diseases.The aim of the study. To identify the features of the epidemiology of communityacquired pneumonia in the conditions of mass immunization against pneumococcal infection in the Irkutsk region.Materials and methods. We conducted a descriptive epidemiological retrospective study. We studied the incidence of community-acquired pneumonia (including community-acquired pneumonia of bacterial and viral etiology) and mortality from this disease in the Irkutsk region for 2011–2022 according to statistical reporting forms No. 2, No. 5, No. 6, C51.Results. The incidence of community-acquired pneumonia during the observation period remained at a high level: the long-term annual average rate among the total population was 627.3 [467.8÷786.8]. At the same time, there was a persistent decrease in the incidence of community-acquired pneumonia of bacterial etiology (Tdecrease = 6.8 %). Incidence rates of community-acquired pneumonia of bacterial etiology were distributed unevenly over  the  years and  the  compared population groups. The highest levels were recorded in children in 2018–2019 – 12.3 [10.8÷13.8] and 19.3 [17.8÷20.8], respectively. A decrease in the mortality rate from community-acquired pneumonia among children, adults and in the general population in 2020 was  shown, with a  subsequent increase in  the  rate among adults and  the  general population by  2.5  times. Against the  background of  ongoing immunization of the population against pneumococcal infection, there is a statistically significant decrease in the incidence of community-acquired pneumonia, including communityacquired bacterial pneumonia, and mortality from community-acquired pneumonia among different population groups.Conclusion. Despite the high incidence of community-acquired pneumonia, a statistically significant decrease in the incidence of community-acquired pneumonia of  bacterial etiology has been shown among children and  adults. The  decrease in mortality from community-acquired pneumonia has continued since the introduction of immunization against pneumococcal infection. The results of the study can be used to optimize epidemiological surveillance and epidemiological control of community-acquired pneumonia at the regional level.

Incidence of Pneumonia, Related Hospitalization, and Mortality Among Younger Unvaccinated IBD Patients in a Nationwide Cohort.

Community Acquired Pneumonia (CAP) is among the most common infections among Inflammatory Bowel Disease (IBD) patients. Our aim was to determine the absolute and relative risk of CAP, related hospitalization, and death among younger (age < 65) unvaccinated IBD patients exposed and unexposed to immunosuppressive medications. We conducted a retrospective cohort study among a nationwide cohort of younger IBD unvaccinated patients in the VAHS. Exposure was administration of any immunosuppressive medication. The primary outcome was the first occurrence of pneumonia; secondary outcomes being pneumonia related hospitalization and mortality. We reported event rate per 1000 person-years, hazard ratio, and 95% confidence intervals (CIs) for each outcome. Among a total of 26,707 patients, 513 patients developed pneumonia. Mean age in years (SD) was 51.67 (11.34) for the exposed and 45.91 (12.34) for the unexposed group. The overall crude incidence rate was 3.2 per 1000 patient-years (PYs) [4.04/1000 PYs in the exposed versus 1.45/1000 PYs in the unexposed]. The overall crude incidence rates for pneumonia-related-hospitalization and mortality 1.12 and 0.09 per 1000 PYs, respectively. In Cox regression, the exposed group was associated with an increased risk of pneumonia (AHR 2.85; 95% CI: 2.21 to 3.66, P < 0.001) and pneumonia-related-hospitalization (AHR 3.46; 95% CI: 2.20 to 5.43, P < 0.001). Overall incidence of CAP among younger unvaccinated IBD patients was 3.2 per 1000 PYs. The overall associated hospitalization rates were low, however, higher amongst those exposed to immunosuppressive medications. This data will help patients and physicians make informed decisions regarding pneumococcal vaccine recommendations.

On the impact of the COVID-19 pandemic on the incidence of community-acquired pneumonia on the example of the region of the European North of Russia

Rationale. During the COVID-19 pandemic, there was a sharp increase in the incidence of community-acquired pneumonia (CAP) in Russia and the Republic of Karelia (RK). Given the high significance of the problem, it is necessary to clarify the causes of the current epidemiological situation. The purpose of the work: to assess the incidence of CAP, not associated with COVID-19, in the adult population of the Republic of Karelia aged 18 years older in 2011–2019 in the administrative-territorial divisions of the republic, a comparison of its existing and projected levels in 2020–2021. Material and method. A retrospective observational epidemiological study was conducted based on the analysis of statistical data of the Republican Medical Information and Analytical Center of the Ministry of Health of the RK on the incidence of CAP, not associated with COVID-19, in the population aged 18 years and older in 2011–2021. Relative values, indicators of the dynamic series are used. To differentiate the administrative-territorial divisions of the RK by incidence in 2011–2019 the method of k-means cluster analysis was applied. To build a forecast for the incidence of CAP, not associated with COVID-19, for 2020–2021 used additive regression model for time series. Results. Among the districts, 3 clusters were identified for the incidence of non-coronavirus CAP in 2011–2019 with the worst epidemiological situation in Olonetsky. The actual incidence exceeded the predicted one in 2020 in 11 and in 2021 in 9 territories of the region, which confirms the impact of the pandemic on the incidence. Conclusion. There are territories in the republic with a “traditionally” high incidence of CAP, and the COVID-19 pandemic has made a significant contribution to its increase.

Infectious Complications of Pulmonary Sarcoidosis.

In this review, the infectious complications observed in sarcoidosis are considered from a practical point of view to help the clinician not to overlook them in a difficult context, as pulmonary sarcoidosis makes the recognition of superinfections more difficult. An increased incidence of community-acquired pneumonia and of opportunistic pneumonia has been reported, especially in immunosuppressed patients. Pulmonary destructive lesions of advanced sarcoidosis increase the incidence of chronic pulmonary aspergillosis and infection by other agents. Screening and treatment of latent tuberculosis infection are crucial to prevent severe tuberculosis. Severity in COVID-19 appears to be increased by comorbidities rather than by sarcoidosis per se. The diagnosis of infectious complications can be challenging and should be considered as a potential differential diagnosis when the exacerbation of sarcoidosis is suspected. These complications not only increase the need for hospitalizations, but also increase the risk of death. This aspect must be carefully considered when assessing the overall health burden associated with sarcoidosis. The impact of immune dysregulation on infectious risk is unclear except in exceptional cases. In the absence of evidence-based studies on immunosuppressants in the specific context of pulmonary sarcoidosis, it is recommended to apply guidelines used in areas outside sarcoidosis. Preventive measures are essential, beginning with an appropriate use of immunosuppressants and the avoidance of unjustified treatments and doses. This approach should take into account the risk of tuberculosis, especially in highly endemic countries. Additionally, parallel emphasis should be placed on vaccinations, especially against COVID-19.

Analysis of the Causes and Conditions for the Formation of a High Incidence of Acute Respiratory Infections (ARI) in the Population of the Altai Krai (Part 1. Features of Long-Term and Intra-Annual Dynamics of ARI Incidence in 2011–2021)

Relevance. The Altai Krai (AK) is among the least prosperous subjects of the Russian Federation in terms of the incidence of acute respiratory infections (ARI).Aim: to analyze the causes and conditions for the formation of a high incidence of ARI among the population of the Altai Krai based on an assessment of the long-term and intra-annual dynamics of the epidemic process in 2011–2021.Materials and methods. In the course of a retrospective epidemiological study according to the annual forms No. 2 of the state statistical observation (SOS) for 2011-2021 a comparative analysis of the incidence of ARI and community-acquired pneumonia (CAP) in various groups of the population of the AK, the Siberian federal district (SFD) and the population of the Russian Federation as a whole was carried out. Data for 2020–2021 («covid» period) was analyzed separately in comparison with the precovid period of 2011–2019. The intra-annual dynamics of the incidence of ARI and CAP in the AK were studied using the method of trend-seasonal decomposition according to the monthly forms No. 2 of the SOS.Results and discussion. It is established that in 2011–2021. the epidemic process of ARI in the AK was characterized by a higher level and rate of increase in the incidence of all population groups (adults and children, urban and rural) compared to the all-Russian and average for the Siberian Federal District; a higher proportion of children in the overall structure of ARI cases, despite the fact that the proportion of the child population did not exceed (or was even less) than in other regions; no decrease in the incidence of ARI in children in the period 2020–2021; the presence of a trend towards an increase in the incidence of ARI in both urban and rural residents in the pre-covid period; higher incidence in the rural population in 2011–2019 compared to the whole of the Russian Federation or the Siberian Federal District. A less pronounced role of the seasonal component in the registration of CAP was revealed, in comparison with ARI. In some years, an increase in the registration of CAP was observed in the spring-summer period. For 2020-2021 there was a close coincidence of the curves of the intra-annual dynamics of the registered incidence of ARI and COVID-19 among the general population, CAP and COVID-19.Conclusion. The obtained results indicate the need to study the possible impact of environmental factors, as well as the shortcomings of the etiological interpretation and differential diagnosis of some natural focal and zoonotic infections that occur with fever and respiratory symptoms on the formation of a high incidence of ARI in the Altai Territory.

Incidence of community-acquired pneumonia among children under 5 years in Suzhou, China: a hospital-based cohort study

ObjectivesTo depict the seasonality and age variations of community-acquired pneumonia (CAP) incidence in the context of the COVID-19 impact.DesignRetrospective cohort study.ParticipantsThe observational cohort study was conducted at Soochow University Affiliated...

Severity of Exacerbation in Pneumococcal Vaccinated versus Unvaccinated Patients with Exacerbation of Chronic Obstructive Pulmonary Disease: A Post hoc Analysis of Presentation Status of the Subjects of HOPE Chronic Obstructive Pulmonary Disease Study

Background: Acute exacerbations occur with varying frequency and severity and impact the natural course of chronic obstructive pulmonary disease (COPD) patients. Pneumococcal vaccination has been shown to decrease the incidence of community-acquired pneumonia and exacerbation rate in COPD patients. There is a paucity of data on the influence of pneumococcal conjugate vaccination on the severity of COPD exacerbations. Objectives: The objectives of this study were to evaluate the severity of exacerbation in pneumococcal vaccinated (vaccinated with 13-valent conjugate vaccine) versus unvaccinated COPD subjects hospitalized with acute exacerbation. Materials and Methods: This was a post hoc analysis of the severity of exacerbation in the subjects of HOPE COPD study. This involved the collection of clinical, radiological, and laboratory data of 120 COPD patients who were hospitalized with an acute exacerbation, 60 of whom had prior pneumococcal vaccination and 60 were unvaccinated. Data of COPD patients at the time of presentation with acute exacerbation were analyzed. Comparison was made between severity parameters such as presence of fever, leukocytosis, respiratory failure, multilobar consolidation, hypotension needing inotropic support, and presence of sepsis between pneumococcal vaccinated and unvaccinated subjects. Results: The occurrence of multilobar consolidation was substantially less in the vaccinated group (60% vs. 6.7%; P = 0.0001). The incidence of fever, leukocytosis, and elevated C-reactive protein was significantly higher in the unvaccinated group. Need for intensive care unit care was higher in the unvaccinated group (58.3% vs. 30% with P = 0.019). The occurrence of new-onset respiratory failure was similar in both the groups although type 2 failure with respiratory acidosis was more in the unvaccinated group. Patients in the unvaccinated group had a higher incidence of sepsis and need for inotropic support as well as assisted ventilation. Conclusions: Prior immunization with 13-valent pneumococcal conjugate vaccine ameliorates the severity of exacerbation in COPD patients needing hospitalization. Pneumococcal vaccination may be recommended for all patients with COPD who are at risk of hospitalization with acute exacerbation.

Community-acquired pneumonia. Current treatment regimens in pediatric practice

At the moment, an increase in the incidence of community-acquired pneumonia is quite an urgent problem. Its solution is based on the use of adequate antibacterial therapy, which will help significantly reduce the spread of the disease among children included in the risk group.&#x0D; Goal: Conducting a comprehensive assessment of etiological therapy tactics for community-acquired bacterial pneumonia in children and determining their compliance with modern clinical recommendations.&#x0D; Materials and methods: The study was conducted on the basis of the Voronezh Childrens Clinical Hospital of the Voronezh State Medical University named after N.N. Burdenko. A retrospective analysis of 18 case histories of patients aged 3 to 14 years who were treated from October 2021 to March 2022 with a diagnosis of community-acquired pneumonia of moderate severity was carried out.&#x0D; Results: During the analysis of the medical histories of children diagnosed with community-acquired pneumonia, it was found that the diagnosis of the patients condition was complete and sufficient in each of the cases considered, with the exception of the absence of sputum in terms of bacteriological examination, because the treatment was more empirical in nature, directed against the frequently detected pathogen determining the formation of this nosological form S. rpeimopiae.&#x0D; Conclusion: As a result of a comprehensive assessment of the tactics of etiological therapy of community-acquired bacterial pneumonia in children, it was revealed that effective antibiotic therapy was chosen for all patients in accordance with the severity of the disease and instructions for the use of antibacterial drugs, which led to the gradual elimination of clinical symptoms of community-acquired pneumonia.

Analysis of the epidemiological situation of community-acquired pneumonia in the Republic of Tatarstan for the period from 2012 to 2021

The incidence of community-acquired pneumonia is an urgent problem of modern healthcare due to its high prevalence, which creates an additional burden on intensively working healthcare systems. An analysis of the epidemiological situation with this nosology over a ten-year period is relevant, since it will allow developing or adjusting measures to reduce the incidence and prevent community-acquired pneumonia in the Republic of Tatarstan. The purpose of this study — to study the dynamics and trends in the incidence of community acquired pneumonia in the population of the Republic of Tatarstan for the period 2012–2021. The study used data from official statistical information of the Office of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare in the Republic of Tatarstan, statistical reference books of the Center for Hygiene and Epidemiology in the Republic of Tatarstan for 2012–2021. The design of the study is a descriptive and evaluative epidemiological study as part of a retrospective epidemiological analysis of the incidence of CAP in the Republic of Tatarstan for 2012–2021. with an analysis of the long-term dynamics of the incidence of the population of the Republic of Tatarstan with the calculation of intensive incidence rates. When assessing the long-term dynamics of the incidence (2012–2021) of community-acquired pneumonia in the Republic of Tatarstan, a trend towards an increase in the incidence was revealed at an average rate of 27.4 ± 0.5 % per year (ρ = 0,748, р &lt; 0,005) (2,3). The indicated trend rate increased the incidence of CAP over 10 years from 451.3 cases per 100 thousand us to 934.3 per 100 thousand us, or 2 times (2.3). The obtained results of assessing the incidence of community-acquired pneumonia over a ten-year period in the Republic of Tatarstan indicate the need for a detailed analysis of the monitoring system for patients with community-acquired pneumonia, as well as the need to improve it to increase the level of preventive measures.

Evaluating clinical effectiveness and safety of pneumococcal immunization of infants

According to WHO, pneumococcal infection (PI) is considered one of the most dangerous of all vaccine-preventable diseases and, before vaccination, led to the death of up to 1.6 million people per year, of which from 0.7 to 1 million were children. In the prevention of PI, specific prevention occupies a special place. For the first time in 2014, vaccination against PI with pneumococcal conjugate vaccine was included in the national calendar of preventive vaccinations. International practice of using pneumococcal vaccine has shown that timely vaccination can produce positive results in the fight against PI. Under observation were 55 children who were vaccinated against PI with the pneumococcal polysaccharide conjugate vaccine (adsorbed), 13 valent according to the national calendar of preventive vaccinations of the Russian Federation. It was revealed that post-vaccination complications after vaccination did not occur in any child. General post-vaccination reactions were observed in the form of a short-term increase in temperature, loss of appetite and sleep disturbances, as well as local reactions in the form of edema, hyperemia, and hardening at the site of vaccine administration. We studied the incidence of community-acquired pneumonia (CAP), acute otitis media and acute respiratory infections among 55 children of the first year of life vaccinated at 2 months and 4.5 months (main group) and 50 children for various reasons not vaccinated against PI (comparison group). A study of the long-term results of 2-fold vaccination in the first year of life and revaccination at 15 months against PV based on observation of children for two years showed that children of the main group, compared with the comparison group, were 3.3 times less likely to suffer from PV, 2.7 times acute otitis and 1.7 times acute respiratory infections, p &lt; 0.05. The data obtained show the high efficiency and safety of vaccinating children against PI with the pneumococcal vaccine.

Poor Social Functioning: A Potentially Modifiable Risk Factor for Pneumonia in the Elderly.

Background Most risk factors for developing community-acquired pneumonia (CAP) are age-related and chronic medical conditions; modifying these factors can be challenging, especially in the elderly. Poor social functioning, however, has a negative impact on medical conditions but can be improved through interventions. Therefore, the social functioning domain of health-related quality of life (HRQOL) may be a modifiable risk factor for the development of CAP. This study investigated the association between poor social functioning and the incidence of CAP in elderly individuals. Methodology We conducted a retrospective cohort study using a dataset from 2018 to 2021, derived from an annual questionnaire-based survey of a cohort of community-dwelling people aged 75 years or older (the Sukagawa Study). The dataset included social functioning subscale scores of HRQOL obtained from the Eight-Item Short Form (SF-8) questionnaire. Health insurance claims data were matched with these HRQOL data. For each participant, the exposure (HRQOL) was measured, and outcomes (incidence of CAP) were observed yearly from 2018 through 2021. Results The four observation years had a total of 17,016 observation periods among 6,513 participants. The annual incidence rate of CAP was 0.90-1.77%. Lower social functioning was associated with a higher risk of CAP. Specifically, for each standard deviation difference in social functioning score, the adjusted rate ratio for CAP incidence was 1.26 (95% confidence interval (CI) = 1.08-1.48). In a subgroup analysis, the association between social functioning and CAP differed by sex (p = 0.037). Specifically, the adjusted rate ratio for CAP incidence was 1.41 (95% CI = 1.17-1.70) in men and 1.00 (95% CI = 0.76-1.35) in women. Conclusions Poor social functioning is an important risk factor for CAP in the elderly, especially in men. Interventions that improve social functioning may help to prevent CAP.

Community-Acquired Pneumonia Incidence in Adults Aged 18 Years and Older in Goto City, Japan: A Prospective Population-Based Study

BackgroundFew studies have measured the burden of community-acquired pneumonia (CAP) and pneumococcal vaccine-type CAP in Japan after the introduction of the 23-valent pneumococcal polysaccharide vaccine into the adult national immunization program (NIP) for individuals ≥ 65 years of age in 2014. In this study, we estimated the incidences of CAP and Streptococcus pneumoniae CAP among Japanese adults between 2015 and 2020.Research QuestionWhat are the incidences of CAP and S pneumoniae CAP among Japanese adults? What are the common pneumococcal serotypes detected in patients with S pneumoniae CAP?Study Design and MethodsThis prospective, population-based, multicenter, active surveillance study enrolled adults ≥ 18 years of age with clinically and radiologically confirmed CAP in Goto City, Japan. S pneumoniae was detected using standard-of-care blood and sputum cultures, BinaxNOW, and serotype-specific urinary antigen detection assays.ResultsA total of 2,103 patients with CAP were enrolled; 84% were ≥ 65 years of age and 6.7% died during the study. The annual CAP, S pneumoniae CAP, 13-valent pneumococcal conjugate vaccine (PCV13) serotype CAP, and 20-valent pneumococcal conjugate vaccine (PCV20) serotype CAP incidences per 100,000 population were 1,280, 227, 63, and 110, respectively. S pneumoniae was detected in 17.8% of all patients with CAP by any detection method, with 4.9%, 5.5%, and 8.6% of cases of CAP resulting from PCV13, 15-valent pneumococcal conjugate vaccine, and PCV20 serotypes, respectively. Applying Goto’s incidence and case fatality rate to the Japanese population, assuming PCV20 has the same vaccine efficacy and duration of protection as PCV13 and if licensed in Japan for the prevention of CAP, the inclusion of PCV20 in the NIP for adults ≥ 65 years of age could prevent 29,036 cases of CAP and 2,275 CAP-related deaths per year.InterpretationGiven the substantial burden of preventable pneumococcal disease, introduction of pneumococcal conjugate vaccines in Japanese adults may be of merit. Few studies have measured the burden of community-acquired pneumonia (CAP) and pneumococcal vaccine-type CAP in Japan after the introduction of the 23-valent pneumococcal polysaccharide vaccine into the adult national immunization program (NIP) for individuals ≥ 65 years of age in 2014. In this study, we estimated the incidences of CAP and Streptococcus pneumoniae CAP among Japanese adults between 2015 and 2020. What are the incidences of CAP and S pneumoniae CAP among Japanese adults? What are the common pneumococcal serotypes detected in patients with S pneumoniae CAP? This prospective, population-based, multicenter, active surveillance study enrolled adults ≥ 18 years of age with clinically and radiologically confirmed CAP in Goto City, Japan. S pneumoniae was detected using standard-of-care blood and sputum cultures, BinaxNOW, and serotype-specific urinary antigen detection assays. A total of 2,103 patients with CAP were enrolled; 84% were ≥ 65 years of age and 6.7% died during the study. The annual CAP, S pneumoniae CAP, 13-valent pneumococcal conjugate vaccine (PCV13) serotype CAP, and 20-valent pneumococcal conjugate vaccine (PCV20) serotype CAP incidences per 100,000 population were 1,280, 227, 63, and 110, respectively. S pneumoniae was detected in 17.8% of all patients with CAP by any detection method, with 4.9%, 5.5%, and 8.6% of cases of CAP resulting from PCV13, 15-valent pneumococcal conjugate vaccine, and PCV20 serotypes, respectively. Applying Goto’s incidence and case fatality rate to the Japanese population, assuming PCV20 has the same vaccine efficacy and duration of protection as PCV13 and if licensed in Japan for the prevention of CAP, the inclusion of PCV20 in the NIP for adults ≥ 65 years of age could prevent 29,036 cases of CAP and 2,275 CAP-related deaths per year. Given the substantial burden of preventable pneumococcal disease, introduction of pneumococcal conjugate vaccines in Japanese adults may be of merit. Take-home PointsStudy Question: What are the incidences of community-acquired pneumonia (CAP) and Streptococcus pneumoniae CAP among Japanese adults?Results: The annual incidences of CAP and S pneumoniae CAP were high in Goto City (1,280 and 227 cases per 100,000 population, respectively) and increased with age.Interpretation: Given the substantial burden of preventable pneumococcal disease, introduction of pneumococcal conjugate vaccines in Japanese adults may be of merit. Study Question: What are the incidences of community-acquired pneumonia (CAP) and Streptococcus pneumoniae CAP among Japanese adults? Results: The annual incidences of CAP and S pneumoniae CAP were high in Goto City (1,280 and 227 cases per 100,000 population, respectively) and increased with age. Interpretation: Given the substantial burden of preventable pneumococcal disease, introduction of pneumococcal conjugate vaccines in Japanese adults may be of merit. Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality. Age of 65 years of older and certain medical conditions are risk factors for CAP,1Torres A. Peetermans W.E. Viegi G. Blasi F. Risk factors for community-acquired pneumonia in adults in Europe: a literature review.Thorax. 2013; 68: 1057-1065Crossref PubMed Scopus (406) Google Scholar and the incidence and mortality of CAP are highest among the elderly.2Ramirez J.A. Wiemken T.L. Peyrani P. et al.Adults hospitalized with pneumonia in the United States: incidence, epidemiology, and mortality.Clin Infect Dis. 2017; 65: 1806-1812Crossref PubMed Scopus (280) Google Scholar,3Theilacker C. Sprenger R. Leverkus F. et al.Population-based incidence and mortality of community-acquired pneumonia in Germany.PLoS One. 2021; 16e0253118Crossref Scopus (15) Google Scholar With 28.7% of the Japanese population being 65 years of age or older, pneumonia was ranked the fifth leading cause of death in 2019 (77.2 deaths per 100,000 population).4Dunne E.M. Cilloniz C. von Mollendorf C. et al.Pneumococcal vaccination in adults: what can we learn from observational studies that evaluated PCV13 and PPV23 effectiveness in the same population?.Archivos de Bronconeumología. 2023; Crossref Scopus (0) Google Scholar Because Japan has become the first super-aged society in the world,5D’Ambrogio E. Japan’s aging society. European Parliament website.https://www.europarl.europa.eu/RegData/etudes/BRIE/2020/659419/EPRS_BRI(2020)659419_EN.pdfDate accessed: September 16, 2022Google Scholar the burden of pneumonia is expected only to increase. Streptococcus pneumoniae is a leading cause of bacterial CAP. However, the use of pneumococcal conjugate vaccine (PCV) has reduced the proportion of disease attributed to S pneumoniae in children and adults.6Moore M.R. Link-Gelles R. Schaffner W. et al.Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance.Lancet Infect Dis. 2015; 15: 301-309Abstract Full Text Full Text PDF PubMed Scopus (551) Google Scholar,7Sherwin R.L. Gray S. Alexander R. et al.Distribution of 13-valent pneumococcal conjugate vaccine Streptococcus pneumoniae serotypes in US adults aged ≥50 years with community-acquired pneumonia.J Infect Dis. 2013; 208: 1813-1820Crossref PubMed Scopus (0) Google Scholar In June 2010, a 7-valent PCV was introduced into the national immunization program (NIP) for children in Japan, replaced by a 13-valent PCV (PCV13) in 2013.8Yanagihara K. Kosai K. Mikamo H. et al.Serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae associated with invasive pneumococcal disease among adults in Japan.Int J Infect Dis. 2021; 102: 260-268Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar PCV13 coverage in Japanese children is high (> 95%), and a substantial decline (45%) in the CAP hospitalization rate has been observed among children younger than 5 years.9Takeuchi N. Naito S. Ohkusu M. et al.Epidemiology of hospitalised paediatric community-acquired pneumonia and bacterial pneumonia following the introduction of 13-valent pneumococcal conjugate vaccine in the national immunisation programme in Japan.Epidemiol Infect. 2020; 148: e91Crossref PubMed Scopus (16) Google Scholar Currently, two pneumococcal vaccines are available in Japan for adults. The 23-valent pneumococcal polysaccharide vaccine (PPSV23) was introduced into the adult NIP in October 2014 for adults ≥ 65 years of age and for adults 60 to 64 years of age with certain medical conditions.8Yanagihara K. Kosai K. Mikamo H. et al.Serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae associated with invasive pneumococcal disease among adults in Japan.Int J Infect Dis. 2021; 102: 260-268Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar The cumulative vaccination rate of PPSV23 among adults ≥ 65 years of age was 74% at the end of 2018.10Naito T. Suzuki M. Fujibayashi K. et al.The estimated impact of the 5-year national vaccination program on the trend of 23-valent pneumococcal polysaccharide vaccine vaccination rates in the elderly in Japan, 2009-2018.J Infect Chemother. 2020; 26: 407-410Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar In 2014, PCV13 was approved in adults ≥ 65 years of age in Japan, and in 2020, this approval was extended to include individuals 6 to 64 years of age with underlying medical conditions. However, PCV13 is not included in the adult NIP in Japan.11Fukusumi M. Chang B. Tanabe Y. et al.Invasive pneumococcal disease among adults in Japan, April 2013 to March 2015: disease characteristics and serotype distribution.BMC Infect Dis. 2017; 17: 2Crossref PubMed Scopus (37) Google Scholar Recently, higher-valent PCVs—15-valent PCV (including PCV13 serotypes plus serotypes 22F and 33F; Merck & Co., Inc.) and 20-valent PCV (PCV20; including PCV13 serotypes and seven additional serotypes: 8, 10A, 11A, 12F, 15B, 22F, and 33F; Pfizer, Inc.)—have been licensed by the US Food and Drug Administration and European Medicines Agency for use in adults ≥ 18 years of age12Committee for Medicinal Products for Human Use, European Medicines AgencySummary of opinion (initial authorisation): Apexxnar. European Medicines Agency website.https://www.ema.europa.eu/en/documents/smop-initial/chmp-summary-positive-opinion-apexxnar_en.pdfDate accessed: September 16, 2022Google Scholar, 13Committee for Medicinal Products for Human Use, European Medicines AgencySummary of opinion (initial authorisation): Vaxneuvance. European Medicines Agency website.https://www.ema.europa.eu/en/documents/smop-initial/chmp-summary-positive-opinion-vaxneuvance_en.pdfDate accessed: September 16, 2022Google Scholar, 14Kobayashi M. Farrar J.L. Gierke R. et al.Use of 15-valent pneumococcal conjugate vaccine and 20-valent pneumococcal conjugate vaccine among U.S. adults: updated recommendations of the Advisory Committee on Immunization Practices - United States, 2022.MMWR Morb Mortal Wkly Rep. 2022; 71: 109-117Crossref PubMed Scopus (87) Google Scholar and are undergoing clinical evaluations in Japan. In an aging society like Japan, it is important to understand the burden of CAP in adults and the degree to which CAP may be prevented with the current and next-generation pneumococcal vaccines. However, while studies have been conducted measuring the burden of CAP and vaccine-type (VT) CAP in Japan, the most comprehensive data were obtained between 2011 and 2013,15Morimoto K. Suzuki M. Ishifuji T. et al.The burden and etiology of community-onset pneumonia in the aging Japanese population: a multicenter prospective study.PLoS One. 2015; 10e0122247Crossref Scopus (128) Google Scholar which was before PPSV23 introduction into the NIP for older adults in 2014. Herein, we present the results from a population-based CAP incidence study among adults in Goto City, Japan, between 2015 and 2020. Although the population aging rate (≥ 65 years) in Goto City (36.8% in 2015) was higher than that in Japan as a whole (29.1% in 2021),16Statistics Bureau of JapanPopulation estimates. Statistics Bureau of Japan website.https://www.stat.go.jp/english/index.htmlDate accessed: January 18, 2023Google Scholar Goto City is epidemiologically similar to Japan as whole. Therefore, the findings in this study are generalizable to Japan. This was a prospective, multicenter, active-surveillance, population-based incidence study. Residents ≥ 18 years of age in Goto City, Japan, with suspected CAP were screened at all hospitals and outpatient clinics. Goto City is located in the southwest part of Japan, encompassing 11 inhabited islands. Of the 39,808 inhabitants, 85% are ≥ 18 years of age.17Glick H.A. Miyazaki T. Hirano K. et al.One-year quality of life post-pneumonia diagnosis in Japanese adults.Clin Infect Dis. 2021; 73: 283-290Crossref Scopus (11) Google Scholar Study participants were recruited between December 2015 and November 2020. All health-care facilities in Goto City, including four hospitals and 25 outpatient clinics, were include in the study. The study was approved by the ethics review committees and was registered in the University Hospital Medical Information Network (registration ID: [removed]). Patients signed the written informed consent before enrollment. All patients who sought treatment at the participating health-care facilities and demonstrated signs, symptoms, and radiographic evidence of pneumonia were screened for inclusion. To be included, patients: (1) had to be ≥ 18 years of age; (2) had to be a resident of Goto City; (3) had to have a diagnosis of pneumonia based on the presence of two or more of the signs and symptoms of cough; purulent sputum; fever (axillary temperature ≥ 37° C); dyspnea, tachypnea, or both; WBC count of > 10,000/mm3 or > 15% bands or WBC count of < 4,500/mm3; elevated C-reactive protein (CRP) level; hypoxemia; or abnormal auscultatory findings suggestive of pneumonia; (4) had to show a pneumonia pattern (eg, alveolar infiltrative shadow associated with air bronchogram) on chest radiography or chest CT scan imaging; and (5) had to be willing and able to provide a urine sample. Patients were excluded if: (1) they were transferred to a participating health-care facility after having been hospitalized for ≥ 48 h at another hospital. (2) they had hospital-acquired pneumonia (ie, pneumonia developed ≥ 48 h after hospitalization), (3) they had received PPSV23 or PCV13 within the past 30 days (because vaccine receipt may cause false-positive urinary antigen detection [UAD] results), or (4) they had been enrolled previously in the study within the past 30 days. For patients who were eligible for the study, demographics, medical history, pneumococcal vaccination history within the last 5 years, pneumonia severity on admission, and clinical outcomes were collected. Patients were followed for up to 30 days after enrollment. The pneumococcal vaccination history was confined to 5 years because PPSV23 was introduced into the adult NIP in 2014 and the study participants were recruited between 2015 and 2020. Further, only a small proportion of participants had received PCV13. Therefore, confining pneumococcal vaccination history to the previous 5 years should have provided a reasonable coverage estimate. The risk status of participants (high risk, at risk, and low risk) was determined based on the presence of certain medical conditions (based on Shea et al18Shea K.M. Edelsberg J. Weycker D. Farkouh R.A. Strutton D.R. Pelton S.I. Rates of pneumococcal disease in adults with chronic medical conditions.Open Forum Infect Dis. 2014; 1: ofu024Crossref PubMed Google Scholar and on the US Advisory Committee on Immunization Practices guidelines) (e-Table 1). Sputum and specimens from normally sterile sites were collected as part of standard-of-care practice and underwent culture at Goto Central Hospital Laboratory. S pneumoniae isolates then were sent to the German National Reference Center for Streptococci for confirmatory testing and serotyping using the Quellung reaction. Urine samples were collected as a study-related procedure for BinaxNOW S pneumoniae antigen card, and UAD assays were performed at Pfizer’s Vaccines Research and Development Laboratory. The UAD assays are multiplex immunoassays based on the Luminex technology. By capturing serotype-specific S pneumoniae polysaccharides secreted in human urine, the UAD assays simultaneously can detect multiple S pneumoniae serotypes.19Kalina W.V. Souza V. Wu K. et al.Qualification and clinical validation of an immunodiagnostic assay for detecting 11 additional Streptococcus pneumoniae serotype-specific polysaccharides in human urine.Clin Infect Dis. 2020; 71: e430-e438Google Scholar,20Pride M.W. Huijts S.M. Wu K. et al.Validation of an immunodiagnostic assay for detection of 13 Streptococcus pneumoniae serotype-specific polysaccharides in human urine.Clin Vaccine Immunol. 2012; 19: 1131-1141Crossref PubMed Scopus (87) Google Scholar The UAD 1 assay detects all 13 serotypes contained in PCV13 (1, 3, 4, 5, 6A/C, 6B, 7F/A, 9V/A, 14, 18C/A/B/F, 19A, 19F, and 23F), and the UAD 2 assay detects 11 additional serotypes (2, 8, 9N, 10A/39, 11A/D/F, 12F, 15B/C, 17F/A, 20A/B, 22F/A, and 33F/A). The UAD 1 and 2 assays and corresponding positivity cutoff values were validated clinically, demonstrating high sensitivity and specificity against urine specimens obtained from patients with radiography-confirmed bacteremic CAP.19Kalina W.V. Souza V. Wu K. et al.Qualification and clinical validation of an immunodiagnostic assay for detecting 11 additional Streptococcus pneumoniae serotype-specific polysaccharides in human urine.Clin Infect Dis. 2020; 71: e430-e438Google Scholar,20Pride M.W. Huijts S.M. Wu K. et al.Validation of an immunodiagnostic assay for detection of 13 Streptococcus pneumoniae serotype-specific polysaccharides in human urine.Clin Vaccine Immunol. 2012; 19: 1131-1141Crossref PubMed Scopus (87) Google Scholar However, the sensitivity and specificity for nonbacteremic CAP have not been determined because of a lack of a reference standard for this outcome. A patient was defined as having CAP if the patient met all the eligibility criteria described previously, was defined as having pneumococcal CAP if the patient had CAP and showed positive culture results for S pneumoniae (including sputum) or BinaxNOW or UAD assay test positive results and was defined as having PCV13 VT CAP or PCV20 VT CAP if the patient had pneumococcal CAP with one of the PCV13 serotypes or PCV20 serotypes detected by culture (including sputum) or the UAD assays. Descriptive statistical analysis was performed. Continuous variables were summarized as mean ± SD, medians, and minimum and maximum values, and a difference in two means and its CI were evaluated by the two-sample t test. Categorical variables were described as frequencies and percentages, and a difference in two proportions and its CI were evaluated by z test based on the binomial theory. Incidences of CAP, pneumococcal CAP, PCV13 VT CAP, and PCV20 VT CAP were calculated with the numerators based on the number of cases and denominators using age-specific population data of Goto City.21McLaughlin J.M. Jiang Q. Gessner B.D. et al.Pneumococcal conjugate vaccine against serotype 3 pneumococcal pneumonia in adults: a systematic review and pooled analysis.Vaccine. 2019; 37: 6310-6316Crossref Scopus (31) Google Scholar Incidence per 100,000 population was shown by age group (18-64 years, 65-79 years, and ≥ 80 years) and by study year (2015 through 2020). For estimating the effect of introducing PCV20 into the adult NIP in Japan, we assumed PCV20 vaccine efficacy (VE) to be the same as that of PCV13 VE, which is 45.56% for the prevention of first episodes of vaccine-type CAP in adults ≥ 65 years of age, as demonstrated in the CAPiTA study.22Bonten M.J. Huijts S.M. Bolkenbaas M. et al.Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults.N Engl J Med. 2015; 372: 1114-1125Crossref PubMed Scopus (836) Google Scholar This assumption was made because PCV20 is built on the manufacturing platform successfully established by PCV13 and the immune responses to PCV20 in adults have been noninferior to PCV13.23Essink B. Sabharwal C. Cannon K. et al.Pivotal phase 3 randomized clinical trial of the safety, tolerability, and immunogenicity of 20-valent pneumococcal conjugate vaccine in adults aged ≥18 years.Clin Infect Dis. 2022; 75: 390-398Crossref PubMed Scopus (0) Google Scholar To calculate CAP cases preventable by PCV20, the PCV20 VT CAP annual incidence rate from Goto City was multiplied by Japan’s population to obtain annual PCV20 VT CAP cases among adults ≥ 65 years of age. Then the annual PCV20 VT CAP cases were multiplied by PCV20 VE of 45.56% to arrive at the number of cases per year preventable by PCV20. To calculate CAP-related deaths preventable by PCV20, the annual all-cause CAP death rate from Goto City was multiplied by Japan’s population to obtain annual all-cause CAP deaths among adults ≥ 65 years of age. Then, the annual all-cause CAP deaths were multiplied by the proportion of CAP cases caused by PCV20 serotypes and PCV20 VE of 45.56% to arrive at CAP-related deaths per year preventable by PCV20. In Japan, the use of PCV13 in adults ≥ 65 years of age is extremely low, and recent evidence supports limited protection against nonbacteremic pneumonia (which makes up by far most cases of pneumococcal pneumonia) in adults vaccinated with PPSV23.4Dunne E.M. Cilloniz C. von Mollendorf C. et al.Pneumococcal vaccination in adults: what can we learn from observational studies that evaluated PCV13 and PPV23 effectiveness in the same population?.Archivos de Bronconeumología. 2023; Crossref Scopus (0) Google Scholar,10Naito T. Suzuki M. Fujibayashi K. et al.The estimated impact of the 5-year national vaccination program on the trend of 23-valent pneumococcal polysaccharide vaccine vaccination rates in the elderly in Japan, 2009-2018.J Infect Chemother. 2020; 26: 407-410Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar Therefore, we expect prior vaccination with either PCV13 or PPSV23 to have little or no effect on the calculations of the potential benefit of PCV20 against pneumonia. Of 2,105 patients screened, 2,103 patients were eligible and included in the analysis population (Table 1). Two screened patients were not included in the analysis because the radiographic findings were not compatible with CAP. The mean age at consent was 77.6 years, 1,765 patients (83.9%) were ≥ 65 years of age, and 53.9% were female. The mean pneumonia severity index (PSI) score on admission was 108.9, with 39.0% and 28.6% of patients having class IV or V PSI scores, respectively. The mean CURB-65 score was 1.7 and 20.7% of patients had a CURB-65 score of 3 to 5. Pneumococcal vaccination within the previous 5 years was reported for 414 of 2,103 patients (19.7%), with 6.8% in adults 18 to 64 years of age and 22.2% in adults ≥ 65 years of age. In total, 70.7% of all patients were hospitalized; the mean hospital stay duration was 14.1 days. Mortality during the study was 6.7% (141/2,103), and in-hospital mortality was 6.2% (130/2,103). Among patients who died, 94.3% (133/141) were ≥ 65 years of age and 5.7% (8/141) were 18 to 64 years of age. Among patients ≥ 18 years of age, 18 to 64 years of age, and ≥ 65 years of age, 69.5%, 64.5%, and 70.4% were at risk or high risk, respectively (Table 2).Table 1Demographics and Clinical Characteristics of Patients With CAPVariableAge Group, y18-64 (n = 338)≥ 65 (n = 1,765)≥ 18 (n = 2,103)Age at consent, y No.3381,7652,103 Mean ± SD51.1 ± 12.182.6 ± 8.677.6 ± 14.8 Median56.084.082.0 Interquartile range19-6465-10319-103Sex Female186 (55.0)948 (53.7)1,134 (53.9) Male152 (45.0)817 (46.3)969 (46.1)Pneumonia severity index No.3381,7642,102 Mean ± SD64.6 ± 32.3117.4 ± 34.0108.9 ± 38.9 Median57.0115.0109.0 Interquartile range13-19455-27513-275 GradeI139 (41.1)102 (5.8)241 (11.5)II82 (24.3)46 (2.6)128 (6.1)III43 (12.7)267 (15.1)310 (14.7)IV59 (17.5)762 (43.2)821 (39.0)V14 (4.1)587 (33.3)601 (28.6)Missing1 (0.3)1 (0.1)2 (0.1)CURB-65 score No.3381,7652,103 Mean ± SD0.3 ± 0.61.9 ± 0.91.7 ± 1.0 Median0.02.02.0 Interquartile range0-41-50-5 0254 (75.1)0 (0.0)254 (12.1) 160 (17.8)708 (40.1)768 (36.5) 222 (6.5)624 (35.4)646 (30.7) 31 (0.3)328 (18.6)329 (15.6) 41 (0.3)102 (5.8)103 (4.9) 50 (0.0)3 (0.2)3 (0.1)Prior vaccine Pneumococcal vaccine within 5 y23 (6.8)391 (22.2)414 (19.7) Prior PPSV23 use9 (2.7)376 (21.3)385 (18.3) Prior PCV13 use15 (4.4)14 (0.8)29 (1.4)Hospitalized Yes145 (42.9)1,342 (76.0)1,487 (70.7) No193 (57.1)423 (24.0)616 (29.3)Hospitalization durationaOnly participants with hospital admission date and discharge date were included in the analysis. No.1239871,110 Mean ± SD13.2 ± 7.714.2 ± 6.914.1 ± 7.0 Median12.013.013.0 Interquartile range1-401-351-40Hospitalization duration ≥ 30 dbPatients with ongoing hospitalization status and with study end date 30 d after hospital admission date were included, in addition to patients with actual stays of ≥ 30 d.27 (8.0)373 (21.1)400 (19.0)Death8 (2.4)133 (7.5)141 (6.7) Death caused by pneumonia5 (1.5)100 (5.7)105 (5.0)Time from hospitalization to death No.8130138 Mean ± SD12.5 ± 9.012.4 ± 8.612.4 ± 8.6 Median11.010.510.5 Interquartile range3-281-311-31Death in hospital7 (2.1)123 (7.0)130 (6.2)Death after hospital discharge1 (0.3)7 (0.4)8 (0.4)Data are presented as No. (%), unless otherwise indicated. CAP = community-acquired pneumonia; PCV13 = 13-valent pneumococcal conjugate vaccine; PPSV23 = 23-valent pneumococcal polysaccharide vaccine.a Only participants with hospital admission date and discharge date were included in the analysis.b Patients with ongoing hospitalization status and with study end date 30 d after hospital admission date were included, in addition to patients with actual stays of ≥ 30 d. Open table in a new tab Table 2Baseline Medical Characteristics of Patients With CAPVariableAge Group, y18-64 (n = 338)≥ 65 (n = 1,765)≥ 18 (n = 2,103)Risk level High86 (25.4)593 (33.6)679 (32.3) At risk132 (39.1)650 (36.8)782 (37.2) Low120 (35.5)522 (29.6)642 (30.5)High risk Chronic renal failure19 (5.6)189 (10.7)208 (9.9) Immunosuppressive therapy41 (12.1)205 (11.6)246 (11.7) Immunodeficiency0 (0.0)0 (0.0)0 (0.0) AIDS0 (0.0)0 (0.0)0 (0.0) HIV infection0 (0.0)0 (0.0)0 (0.0) Hematologic cancer3 (0.9)41 (2.3)44 (2.1) Cancer (solid tumor)43 (12.7)276 (15.6)319 (15.2) Organ transplantation1 (0.3)0 (0.0)1 (0.0) Biologic agent2 (0.6)8 (0.5)10 (0.5) Splenectomy2 (0.6)9 (0.5)11 (0.5) No. of high-risk conditions162 (18.3)473 (26.8)535 (25.4)223 (6.8)106 (6.0)129 (6.1)31 (0.3)13 (0.7)14 (0.7)≥ 40 (0.0)1 (0.1)1 (0.0)1 with ≥ 1 at-risk condition38 (11.2)313 (17.7)351 (16.7)≥ 2 with ≥ 1 at-risk condition10 (3.0)84 (4.8)94 (4.5)At risk COPD20 (5.9)331 (18.8)351 (16.7) Asthma44 (13.0)167 (9.5)211 (10.0) Congestive heart failure10 (3.0)339 (19.2)349 (16.6) Diabetes mellitus38 (11.2)404 (22.9)442 (21.0) Liver disease38 (11.2)220 (12.5)258 (12.3) Smoke100 (29.6)93 (5.3)193 (9.2) No. of at-risk conditions197 (28.7)435 (24.6)532 (25.3)228 (8.3)173 (9.8)201 (9.6)36 (1.8)34 (1.9)40 (1.9)≥ 41 (0.3)8 (0.5)9 (0.4)Other risk factors Used antibiotics in the past 90 d72 (21.3)545 (30.9)617 (29.3) Living with children88 (26.0)19 (1.1)107 (5.1)Data are presented as No. (%). CAP = community-acquired pneumonia. Open table in a new tab Data are presented as No. (%), unless otherwise indicated. CAP = community-acquired pneumonia; PCV13 = 13-valent pneumococcal conjugate vaccine; PPSV23 = 23-valent pneumococcal polysaccharide vaccine. Data are presented as No. (%). CAP = community-acquired pneumonia. Among all patients, the annual incidence of CAP was 1,280 cases per 100,000 population. CAP incidence increased with age, and the incidence among adults ≥ 80 years of age was 11.8 times the incidence among adults 18 to 64 years of age (4,288 per 100,000 population vs 362 per 100,000 population) and 3.2 times the incidence among those 65 to 79 years of age (4,288 per 100,000 population vs 1,352 per 100,000 population) (Fig 1). A similar relationship between incidence and age was observed for pneumococcal CAP, PCV13 VT CAP, and PCV20 VT CAP. In all adults 18 to 64 years of age, those 65 to 79 years of age, and those ≥ 80 years of age, annual incidences per 100,000 population were 227, 89, 260, and 645, respectively, for pneumococcal CAP; 63, 23, 80, and 171, respectively, for PCV13 VT CAP; and 110, 47, 159, and 244, respectively, for PCV20 VT CAP. Extrapolating the CAP incidence and the case fatality rate to Japan’s population and assuming PCV20 has the same VE and duration of protection as PCV13,22Bonten M.J. Huijts S.M. Bolkenbaas M. et al.Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults.N Engl J Med. 2015; 372: 1114-1125Crossref PubMed Scopus (836) Google Scholar if licensed, PCV20 immunization in Japanese adults ≥ 65 years of age could prevent 29,036 CAP cases and 2,275 CAP-related deaths per year. Between 2015 and 2020, CAP incidence and pneumococcal CAP incidence generally remained stable, except for year 5 (December 2019-November 2020) during which the incidences were lower compared with other study years (Fig 2). Urine samples were not collected in 68 of 2,103 patients (3.2%); however, S pneumoniae was detected by culture in 5 of 68 patients (7.3%) from whom a urine sample was not collected. Among 2,099 patients who had diagnostic results available, S pneumoniae was detected in 373 patients (17.8%) by UAD assays, BinaxNOW, or culture (Table 3). S pneumoniae was detected by UAD alone in 78 of 2,099 patients (3.7%; 78/373 patients [20.9%] with pneumococcal CAP), by BinaxNOW alone in 125 of 2,099 patien

Burden of Acute-Care Hospitalization for Community-Acquired Pneumonia in Canadian Adults Aged 50 Years or Older: Focusing on Most Responsible Diagnosis Tells Only Part of the Story.

The burden of all-cause community-acquired pneumonia (CAP), including pneumococcal pneumonia, is typically estimated using ICD codes where pneumonia is coded as the most responsible diagnosis (MRDx). Pneumonia may also be coded as other than most responsible diagnosis (ODx) based on administrative and reimbursement criteria. Analyses including pneumonia as MRDx only likely underestimate hospitalized CAP incidence. The aim of this study was to estimate the burden of hospitalized all-cause CAP in Canada and to assess the contribution of ODx-coded cases to the overall disease burden. This longitudinal retrospective study obtained data from the Canadian Institutes of Health Information (CIHI) for adults 50+ years hospitalized for CAP between 1 April 2009 and 31 March 2019. Cases were identified as those where pneumonia was either diagnosis code type M (MRDx) or pre-admit comorbidity type 1 (ODx). Reported outcomes include pneumonia incidence rate, in-hospital mortality, hospital length of stay, and cost. Outcomes were stratified by age group, case coding, and comorbidity. Between 2009-2010 and 2018-2019, CAP incidence increased from 805.66 to 896.94 per 100,000. During this time, 55-58% of cases had pneumonia coded as ODx. Importantly, these cases had longer hospital stays, higher in-hospital mortality, and higher cost of hospitalization. The burden of CAP remains substantial and is significantly greater than that estimated by solely focusing on MRDx-coded cases. Our findings have implications for policy decision making related to current and future immunization programs.

A Retrospective Study on Factors Associated with Severe Childhood Community-Acquired Pneumonia

Background and Aim: Globally, community-acquired pneumonia (CAP) is the most common source of mortality among children. Early diagnosis and effective management need the identification of risk factors. The purpose of this study was to characterize the clinical symptoms and investigation of various risk factors for severe CAP in children. Patients and Methods: A retrospective study was conducted on 186 children in the Pediatric Department of Niazi Welfare Teaching Hospital, Sargodha from March 2022 to November 2022. Children with pneumonia who had radiological confirmation were included. Community-acquired pneumonia cases were categorized into two groups: Group-I composed of severe CAP cases whereas Group-II non-severe CAP cases. Baseline characteristics such as age, nutritional status, and gender were collected. Vital signs, fever, duration of symptoms, and physical findings such as chest retraction, cyanosis, wheezing, and nasal faring were clinical data recorded. Laboratory findings such as serum electrolyte, full blood count, and inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were recorded. SPSS version 27 was used for data analysis. Results: Of the total 186 children, there were 74 (39.8%) females and 112 (60.2%) male. Age-wise distribution of patients were as follows: 146 (78.5%) in 0-5 years, 26 (14%) in 6-10 years, and 14 (7.5%) in 11-15 years. Out of 186 children, the incidence of severe and non-severe CAP was 58 (31.2%) and 130 (68.8%) respectively. The most common clinical signs in both categories are fever and cough, followed by reduced appetite, vomiting, and shortness of breath. A seizure is present in 14 (24.1%) severe CAP cases. Based on physical examination, Rhonchi is found in 94 (72.3%) non-severe and 46 (79.3%) severe CAP patients. Among patients with severe pneumonia, over half have chest retractions, but only 22% have non-severe pneumonia. Tachypnea was experienced by approximately 33% of severe pneumonia patients against 14% of individuals with non-severe pneumonia. As inflammatory indicators, ESR and CRP are high in all groups. Conclusion: The present study concluded that a fever persisting for &gt;7 days and an elevation in RR are risk factors for severe pneumonia. Severe pneumonia is also prevented by a normal hematocrit level and BMI. There was a higher rate of severe pneumonia in CAP hospitalizations in children who had fevers lasting longer than seven days as well as tachypnea. According to these findings, RR should be utilized to determine both the severity of pneumonia and the identification of pneumonia. Keywords: Sever community-acquired pneumonia, Risk factors, Childhood pneumonia

Hospitalisation outcomes in pneumococcal-vaccinated versus -unvaccinated patients with exacerbation of COPD: results from the HOPE COPD Study.

Infectious exacerbations are crucial events that dictate the natural course of COPD patients. Pneumococcal vaccination has been shown to decrease incidence of community-acquired pneumonia in COPD patients. There is a paucity of data on outcomes of hospitalisation in pneumococcal-vaccinated COPD patients in comparison with unvaccinated subjects. The objectives of the present study were to evaluate the difference in hospitalisation outcomes in pneumococcal-vaccinated versus -unvaccinated COPD subjects hospitalised with acute exacerbation. This was a prospective analytical study on 120 subjects hospitalised with acute COPD exacerbation. 60 patients with prior pneumococcal vaccination and 60 unvaccinated patients were recruited. Outcomes of hospitalisation such as mortality rate, need for assisted ventilation, length of hospital stay, need for intensive care unit (ICU) care and length of ICU stay were collected and compared between two groups with appropriate statistical tools. 60% of unvaccinated patients (36 out of 60) required assisted ventilation, whereas only 43.3% of vaccinated subjects (26 out of 60) needed assisted ventilation (p-value of 0.04). Most of the secondary outcomes were better in the vaccinated group. The mean±SD length of ICU stay in the vaccinated group was 0.67±1.11 days compared to 1.77±1.89 days in the unvaccinated group. The mean±SD length of hospital stay was 4.50±1.64 days and 5.47±2.03 days in the vaccinated and unvaccinated group, respectively (p-value of 0.005). COPD patients who have received prior pneumococcal vaccination have better outcomes when they are hospitalised for an acute exacerbation. Pneumococcal vaccination may be recommended for all patients with COPD who are at risk of hospitalisation with acute exacerbation.

Mycoplasma pneumoniae – modern data on the structure, molecular biology and epidemiology of the pathogen

Mycoplasma pneumoniae is a common etiologic agent of respiratory tract infections and community-acquired pneumonia (CAP) in children and adults. Recently, much new data on this pathogen, its molecular biology, cytoadherence and epidemiology have been accumulated. This review describes in detail the features of the microorganism and the pathogenesis of the diseases caused, clinical manifestations, provides data on the epidemiology of the incidence of respiratory mycoplasmosis and CAP caused by this microorganism in the world, discusses the issues of asymptomatic carriage, considers the problems of laboratory diagnosis, antibiotic therapy and antibiotic resistance of the pathogen.

Retrospective Analysis of the Initial Empirical Antibiotic Therapy Effectiveness for Community-Acquired Pneumonia in Young Individuals in Moscow Multidisciplinary Hospital

Despite the fact that the incidence of community-acquired pneumonia (CAP) among young people is significantly lower than among older patients, the frequency of hospitalizations for severe CAP among people under 45 years of age remains high. The effectiveness and duration of treatment directly depend on the rationally selected initial empirical antibacterial therapy (ABT).The aim of the study is to analyze the factors influencing the effectiveness of initial empiric antibacterial therapy for CAP in young people in multidisciplinary medical institutions.Materials and methods. The study was designed as a retrospective observational study; it analyzes 105 medical records of young patients with CAP admitted to one of the multidisciplinary hospitals in Moscow from 2017 to 2019.Results. The empiric ceftriaxone + azithromycin ABT regimen (70% of all prescriptions) was ineffective in 13.7% of cases; monotherapy with ceftriaxone (13% of all prescriptions) was ineffective in 57% cases. Severe CAP, acute respiratory failure, systemic inflammatory response syndrome, and exudative pleurisy were diagnosed with significantly higher frequency in the group of patients with ineffective initial empirical ABT. There was no predominance of any comorbid pathology and Charlson Comorbidity Index in groups where the initial ABT was changed and in groups without a change in initial ABT. The microbiological spectrum of CAP pathogens did not significantly differ in young patients between groups with a changed initial empirical ABT and a group without changing initial ABT.Conclusion. The reasons for the ineffectiveness of the initial empirical ABT could be such factors as: underestimation of the risk of the presence of multidrug-resistant pathogens; underestimation of the risk of viral genesis of CAP; underestimation of the severity of CAP, as well as the severity of CAP complications.

Cytokine profile in community-acquired pneumonia in children

Community-acquired pneumonia (CAP) is one of the most common acute infectious diseases. To date, the incidence of CAP among children was decreased significantly worldwide, mainly due to increasing use of effective preventive measures. Nevertheless, CAP remains a common cause of childhood morbidity and mortality. Pneumonia may develop at any age, but most often it occurs in young children, who are more likely to have a more severe course of pneumonia. Currently, early diagnosis and prognosis of the disease severity in children is an urgent issue. It was found that, in most cases, a panel of conventional biomarkers, including the number of leukocytes, procalcitonin, CRP is not sufficient for the diagnosis of pediatric CAP. There is a demand for new biological markers which, along with clinical evaluation, may significantly improve diagnostics and management of CAP in children, thus reducing the risk of adverse outcomes associated with this disease. Such markers could be found among the cytokines, which are active participants in the CAP pathogenesis. The aim of this study was to determine the level of several cytokines in blood serum of children with CAP and to assess changes in the cytokine profile depending on the patient’s age and severity of the disease. The study included 117 children aged 1 to 18 years with a diagnosis of CAP confirmed by X-ray examination. The comparison group included 28 healthy children who did not have CAP or other signs of acute respiratory viral infection at the time of examination, being free of any chronic pathology requiring outpatient observation. A number of cytokines were determined quantitatively in blood serum, i.e., IL-1β, IFNγ, IL-2, IL-4, IL-6, IL-10, TNFα, IFNλ2 (IL-28A), IFNλ3 (IL-28B), IL-8, MCP-1, IL-17AF, GM-CSF using test systems based on the “sandwich” method of solid-phase ELISA using peroxidase labeling. As a result, it was found that the content of IL-6, IL-17AF, IL-1β, IFNγ, MCP-1, IFNλ2 (IL-28A), IFNλ3 (IL-28B), GM-CSF was significantly higher in the group of children with severe community-acquired pneumonia. The levels of certain cytokines, e.g., IL-6, IFNλ2 (IL-28A), IFNλ3 (IL-28B), GM-CSF varied depending on the age of patients, thus, probably, reflecting the degree of immune system activation in the children of different age groups.