scholarly journals Age-stratified burden of pneumococcal community acquired pneumonia in hospitalised Canadian adults from 2010 to 2015

2020 ◽  
Vol 7 (1) ◽  
pp. e000550 ◽  
Author(s):  
Jason LeBlanc ◽  
May ElSherif ◽  
Lingyun Ye ◽  
Donna MacKinnon-Cameron ◽  
Ardith Ambrose ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Burden Of Illness ◽  
Pneumococcal Vaccination ◽  
Community Acquired Pneumonia ◽  
Age Cohorts ◽  
Vaccine Recommendations ◽  
Vaccine Type ◽  
Age Cohort ◽  
Testing Patient ◽  
The Impact

BackgroundIn Canada, 13-valent pneumococcal conjugate vaccine (PCV13) is recommended in childhood, in individuals at high risk of invasive pneumococcal disease (IPD) and in healthy adults aged ≥65 years for protection against vaccine-type IPD and pneumococcal community-acquired pneumonia (pCAP). Since vaccine recommendations in Canada include both age-based and risk-based guidance, this study aimed to describe the burden of vaccine-preventable pCAP in hospitalised adults by age.MethodsSurveillance for community-acquired pneumonia (CAP) in hospitalised adults was performed prospectively from 2010 to 2015. CAP was radiologically confirmed, and pCAP was identified using blood and sputum culture and urine antigen testing. Patient demographics and outcomes were stratified by age (16–49, 50–64, ≥65 and ≥50 years).ResultsOf 6666/8802 CAP cases tested, 830 (12.5%) had pCAP, and 418 (6.3%) were attributed to a PCV13 serotype. Of PCV13 pCAP, 41% and 74% were in adults aged ≥65 and ≥50 years, respectively. Compared with non-pCAP controls, pCAP cases aged ≥50 years were more likely to be admitted to intensive care units (ICUs) and to require mechanical ventilation. Older adults with pCAP were less likely to be admitted to ICU or required mechanical ventilation, given their higher mortality and goals of care. Of pCAP deaths, 67% and 90% were in the ≥65 and ≥50 age cohorts, respectively.ConclusionsAdults hospitalised with pCAP in the age cohort of 50–64 years contribute significantly to the burden of illness, suggesting that an age-based recommendation for adults aged ≥50 years should be considered in order to optimise the impact of pneumococcal vaccination programmes in Canada.

scholarly journals 2715. Pneumococcal Community-Acquired Pneumonia Attributed to PCV13 Serotypes in Hospitalized Adults: Comparison of the 50–64 and 65+ Age Groups

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S955-S955
Author(s):  
Jason J LeBlanc ◽  
May ElSherif ◽  
Lingyun Ye ◽  
Donna MacKinnon-Cameron ◽  
Ardith Ambrose ◽  
...  
Keyword(s):  
Herd Immunity ◽  
Age Groups ◽  
Outcome Data ◽  
Community Acquired Pneumonia ◽  
Childhood Immunization ◽  
Age Cohorts ◽  
Vaccine Type ◽  
Age Cohort ◽  
Canadian Provinces ◽  
Quellung Reaction

Abstract Background In healthy adults aged ≥65 years, direct immunization with the 13-valent pneumococcal conjugate vaccine (PCV13) was shown effective at preventing vaccine-type pneumococcal community-acquired pneumonia (pCAP) and invasive pneumococcal disease (IPD). Although PCV13 was licensed for use in Canadian adults aged >50 years, it was recommended for immunocompromised individuals who are at highest risk of IPD. In 2016, a recommendation was issued for use of PCV13 in immunocompetent adults aged ≥65 years, for the prevention of pCAP and IPD. This study aimed to compare pCAP cases attributed to PCV13 serotypes in adults aged 50–64 and ≥65 years. Methods Active surveillance for CAP and IPD was performed from 2010 to 2015 in adult hospitals across five Canadian provinces. To identify pCAP, blood culture, sputum culture, or a PCV13 serotype-specific urine antigen detection (ssUAD) were used. Serotype was assigned using Quellung reaction, PCR, or ssUAD. All pCAP cases were categorized by serotype and age groups. Patient demographics and outcome data were collected. Results Over years 2010–2015, 6687 CAP cases were tested. 835 pCAP cases were identified, of which 418 (50%) caused by a PCV13 serotype. The majority (74%) of PCV13-associated pCAP occurred in the adults aged ≥50 years, whereas only 41.4% (173/418) were in adults ≥65 years. PCV13 pCAP cases declined over the years, likely through herd immunity from childhood immunization. The yearly proportion of pCAP attributed to PCV13 serotypes for ages ≥50 remained high (67.5 to 80.6%), compared those occurring in the ≥65 age groups (35.1 to 49.4%). Compared with test-negative controls, pCAP cases in both age groups were more likely to be admitted to ICU, require mechanical ventilation, and had higher mortality. Of pCAP deaths, 61.4% and 82.3% were in the ≥65 and ≥50 age cohorts, respectively. Conclusion From year 2010 to 2015, adults hospitalized with PCV13 pCAP in the ≥65 age cohort accounted for less than half of the cases, whereas including the 50–64 age cohort increased the proportion to 74%. Similarly, the proportion of PCV13 pCAP deaths that occurred in adults aged ≥50 years was 82%, compared with 61% in the ≥65 age cohort. Expansion of PCV13 recommendations to include adults 50–64 years of age should be considered. Disclosures All authors: No reported disclosures.

scholarly journals Evaluation of the impact of childhood 13-valent pneumococcal conjugate vaccine introduction on adult pneumonia in Ulaanbaatar, Mongolia: study protocol for an observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Claire von Mollendorf ◽  
Mukhchuluun Ulziibayar ◽  
Bradford D. Gessner ◽  
Lien Anh Ha Do ◽  
Cattram D. Nguyen ◽  
...  
Keyword(s):  
Pneumococcal Vaccination ◽  
Health Impact ◽  
Population Based ◽  
Community Acquired Pneumonia ◽  
Primary Objective ◽  
Asia Pacific ◽  
Vaccine Type ◽  
Indirect Impact ◽  
Syncytial Virus ◽  
The Impact

Abstract Background Community-acquired pneumonia is an important cause of morbidity and mortality in adults. Approximately one-third of pneumonia cases can be attributed to the pneumococcus. Pneumococcal conjugate vaccines (PCVs) protect against colonisation with vaccine-type serotypes. The resulting decrease in transmission of vaccine serotypes leads to large indirect effects. There are limited data from developing countries demonstrating the impact of childhood PCV immunisation on adult pneumonia. There are also insufficient data available on the burden and severity of all-cause pneumonia and respiratory syncytial virus (RSV) in adults from low resource countries. There is currently no recommendation for adult pneumococcal vaccination with either pneumococcal polysaccharide vaccine or PCVs in Mongolia. We describe the protocol developed to evaluate the association between childhood 13-valent PCV (PCV13) vaccination and trends in adult pneumonia. Methods PCV13 was introduced into the routine childhood immunisation schedule in Mongolia in a phased manner from 2016. In March 2019 we initiated active hospital-based surveillance for adult pneumonia, with the primary objective of evaluating trends in severe hospitalised clinical pneumonia incidence in adults 18 years and older in four districts of Ulaanbaatar. Secondary objectives include measuring the association between PCV13 introduction and trends in all clinically-defined pneumonia, radiologically-confirmed pneumonia, nasopharyngeal carriage of S. pneumoniae and pneumonia associated with RSV or influenza. Clinical questionnaires, nasopharyngeal swabs, urine samples and chest radiographs were collected from enrolled patients. Retrospective administrative and clinical data were collected for all respiratory disease-related admissions from January 2015 to February 2019. Discussion Establishing a robust adult surveillance system may be an important component of monitoring the indirect impact of PCVs within a country. Monitoring indirect impact of childhood PCV13 vaccination on adult pneumonia provides additional data on the full public health impact of the vaccine, which has implications for vaccine efficiency and cost-effectiveness. Adult surveillance in Mongolia will contribute to the limited evidence available on the burden of pneumococcal pneumonia among adults in low- and middle-income countries, particularly in the Asia-Pacific region. In addition, it is one of the few examples of implementing prospective, population-based pneumonia surveillance to evaluate the indirect impact of PCVs in a resource-limited setting.

Poorer Survival in Multiple Myeloma Correlates with Patients’ Age and Is Linked to a Higher Stage at Presentation but Prognostic Parameters Reflecting the Biology of the Myeloma Clone Are Not Associated with Age.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1491-1491 ◽  
Author(s):  
Heinz Ludwig ◽  
Brian G.M. Durie ◽  
Erik Rasmussen ◽  
John Crowley
Keyword(s):  
Multiple Myeloma ◽  
Prognostic Factors ◽  
Serum Albumin ◽  
Prognostic Parameters ◽  
Age Cohorts ◽  
Number Of Patients ◽  
Age Cohort ◽  
The Impact ◽  
Tumor Clone ◽  
Low Serum

Abstract Up to now no systematic analysis on the impact of different age categories on survival in patients with multiple myeloma has been reported. Information on possible correlations of host and tumor related prognostic factors with different age categories are lacking. We studied these parameters in a large cohort of patients with multiple myeloma (n=10.750) submitted by participating institutions and groups in the international staging system (ISS) project. Prognostic factors were recorded and age was calculated at start of initial chemotherapy. Patients were grouped into 6 age cohorts (<40, 40−<50, 50−<60, 60−<70, 70−<80 and ≥80 years). P values were calculated with the Jonckheere-Terpstra test and Spearman’s correlation coefficient was used where appropriate. The sequential median survivals constantly decreased by decade from 61 months to 60, 53, 40, 32 and 24 months in the 6 patient cohorts from age < 40 years to age >80 years examined, respectively, with a median value of 44 months (p<0.0001). The distribution of prognostic factors by age revealed a highly significant correlation between high serum ß2 microglobulin ( Sß2M, ≥3.5mg/dl) and age, ranging from 45% in patients in the youngest to 75% of patients in the oldest age cohort (r=0.17 (0.15–0.19), p<0.0001). A similar correlation was seen between low serum albumin (<3.5g/dl) and age: The proportion of patients with low serum albumin levels increased from 32% in patients at age < 40 years to 54% in patients > 80 years (r= −0.11(−0.13, −0.09), p<0.0001). Consequently, as Sß2M and serum albumin constitute the prognostic parameters of the ISS, a close correlation between ISS stage and age was found (p< 0.0001). The proportion of patients with ISS stage I (Sß2M < 3.5mg/dl and serum albumin ≥ 3.5 mg/dL) was 40% in patients aged <40 years and only 12% in those aged ≥80 years. In contrast, 44% of patients of the oldest and 31% of the youngest age cohort presented with ISS stage III. In addition, a similar, albeit lesser trend was noted for decreasing hemoglobin with age (r=−0.08 (−0.10, −0.07, p<0.0001) and increasing serum creatinine with age (r=0.08 (0.06, 0.10), p <0.0001). The parameters reflecting the biology of the myeloma clone did not vary between different age cohorts. Bone marrow plasma cell infiltration (BMPC) ≥33%, CRP levels ≥0.8 (mg/dL) and normal LDH was seen in similar frequencies in the different age categories. Similarly, no age dependent variation in cytogenetically defined prognostic variables was seen. The proportion of patients with Del 13 and of those with t (11; 14), t (4; 14) did not differ between the different age categories; these data were obtained in a limited number of patients only (616, 544 and 418 patients, respectively). In conclusion, age was identified as important prognostic factor in the six different age cohorts examined. Poorer survival with higher age is closely linked to higher ISS stage. In addition, creatinine and low hemoglobin correlate, albeit to a lesser degree, with increasing age, but not parameters reflecting adverse biologic features of the tumor clone (LDH, BMPC, CRP, del 13, t(11;14) t(4;14). Hence, an ailing host and not a more aggressive tumor clone seems to account for the inverse correlation between survival and age.

Generational differences in work quality characteristics and job satisfaction

2018 ◽  
Vol 6 (3) ◽  
pp. 287-304 ◽  
Author(s):  
Maureen Snow Andrade ◽  
Jonathan H. Westover
Keyword(s):  
Job Satisfaction ◽  
Generational Differences ◽  
Large Scale ◽  
Quality Characteristics ◽  
Work Quality ◽  
Content Type ◽  
Age Cohorts ◽  
Age Cohort ◽  
The Impact ◽  
The Relationship

Purpose The purpose of this paper is twofold: first, to determine if job satisfaction increases with age, and if this is consistent across countries; and second, if individuals belonging to the same age cohort, who experience similar life conditions and events and have been posited to share common attitudes and behaviors, differ in terms of job satisfaction, and if this difference is comparable across countries. Design/methodology/approach The study provides a comparative analysis of the impact of age and generational differences on job satisfaction globally, based on non-panel longitudinal data from the most recent wave of the International Social Survey Program (Work Orientations IV, 2015). Findings Age has a positive statistically significant impact on job satisfaction (e.g. the older you get, the more satisfied you are with your job). However, the same analysis with each specific age cohort indicates that age is only statistically significant with the baby boomers. Statistically significant cross-generational differences exist in the levels of job satisfaction across generations and cross-generational differences in the determinants of job satisfaction. Most differences are seen between the silent generation and the other three age cohorts. Originality/value Previous comparative studies have found that job satisfaction across generations, even within the same or similar countries, shows little variation. Research measuring the relationship between age and job satisfaction indicates three key contradictory findings – satisfaction increases with age, decreases with age, or no relationship exists. The current large-scale, global study updates and extends previous research by exploring similarities and differences in job satisfaction and work quality characteristics by age cohort, with a global sample.

scholarly journals Estimation of the Potential Benefits of Meningococcal Vaccination in Children at 9 and 12 Months of Age Using a Predictive Mathematical Model

2020 ◽  
Vol 19 (5) ◽  
pp. 84-92
Author(s):  
N. I. Briko ◽  
O. I. Volkova ◽  
I. S. Korolyova ◽  
E. O. Kurilovich ◽  
L. D. Popovich ◽  
...  
Keyword(s):  
Economic Benefits ◽  
Economic Consequences ◽  
Meningococcal Infection ◽  
Model Calculations ◽  
Age Cohorts ◽  
Age Cohort ◽  
To Come ◽  
Social Gain ◽  
The Cost ◽  
The Impact

Relevance. To address the issue of including vaccines against meningococcal infection (MI) in the Russian National Immunization Schedule (NIS), convincing arguments must be presented that demonstrate not only epidemiological, but also economic benefits.Aim of this study was conducted to confirm them.Materials & methods. For calculating epidemiological consequences, a dynamic predictive simulation model was constructed to compare the potential epidemiological burden of the disease in the current vaccination scenario (no MI vaccination in the NIS) and a new scenario involving vaccination of children aged 9 and 12 months with the MenACWY-d vaccine. The epidemiological outlook for meningococcal infection was assessed based on the dynamics of the main indicators of its prevalence in the General population that developed in previous years, taking into account the impact of double vaccination of children at 9 and 12 months on the survival period of each age cohort vaccinated in 2019–2034. The aim is to assess the predicted socio-economic consequences for different scenarios: while maintaining the current vaccination algorithm and including in the NIS vaccination against MI of all children aged 9 and 12 months using mathematical modeling.Results and discussion. The greatest impact on reducing the number of clinical cases of the disease will be achieved in the age cohorts 0–1 years (-89%), 1–2 years (-84.5%), 3–6 years (-73.6%). Model calculations show that due to double vaccination of children under one year of age, 571 deaths can be expected to be prevented by 2034, which is equivalent to a reduction in losses of 40,509 years of life ahead and a social gain of 104.7 billion rubles in the monetary equivalent of the cost of these years (cumulative total). At the same time, taking into account the prevented cases of the disease, the total monetary equivalent of the benefits of society will begin to exceed the cost of vaccination earlier than in four years.Conclusions thus, even an underestimated estimate of benefits that does not take into account the total amount of damage prevented (prevention of 571 deaths, loss of 40,509 years of life and 104.7 billion rubles in monetary terms of the cost of years of life to come), indicates the obvious importance of expanding the NIS and including vaccination of children aged 9 and 12 months from meningococcal infection.

scholarly journals Lymphopenia is associated with poor outcomes of patients with community-acquired pneumonia and sepsis

2021 ◽  
Author(s):  
Catia Cillóniz ◽  
Héctor José Peroni ◽  
Albert Gabarrús ◽  
Carolina García-Vidal ◽  
Juan M Pericàs ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Chronic Renal Disease ◽  
Multivariable Analysis ◽  
Pneumococcal Vaccination ◽  
Hospital Length ◽  
Community Acquired Pneumonia ◽  
Hospital Length Of Stay ◽  
Icu Admission ◽  
Tertiary Teaching ◽  
The Impact

Abstract Background Lymphopenia is a marker of poor prognosis in patients with community-acquired pneumonia (CAP), yet its impact on outcomes in patients with CAP and sepsis remains unknown. We aim to investigate the impact of lymphopenia on outcomes, risk of ICU admission and mortality in CAP patients with sepsis. Methods This was a retrospective, observational study of prospectively collected data from an 800-bed tertiary teaching hospital (2005-2019). Results Of the 2,203 patients with CAP and sepsis, 1,347 (61%) did not have lymphopenia, while 856 (39%) did. When compared to the non-lymphopenic group, patients with sepsis and lymphopenia more frequently required intensive care unit (ICU) admission (p=0.001), had a longer hospital length of stay (p˂0.001), and presented with a higher rate of in-hospital (p˂0.001) and 30-day mortality (p=0.001). Multivariable analysis showed that C-reactive protein ≥15 mg/dL, lymphopenia, pleural effusion and acute respiratory distress syndrome within 24h of admission were risk factors for ICU admission; age ≥80 years was independently associated with decreased ICU admission. In addition, age (≥80 years), chronic renal disease, chronic neurologic disease, nursing home resident, lymphopenia and pleural effusion were independently associated with increased 30-day mortality, whereas pneumococcal vaccination, diabetes mellitus and fever were independently associated with reduced 30-day mortality. Conclusions Lymphopenia was independently associated with the risk of ICU admission and higher in-hospital and 30-day mortality in patients with CAP and sepsis. Early identification of lymphopenia could help identify septic patients with CAP who require or will shortly require critical care.

scholarly journals Lower peripheral blood Toll-like receptor 3 expression is associated with an unfavorable outcome in severe COVID-19 patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maria Clara Saad Menezes ◽  
Alicia Dudy Müller Veiga ◽  
Thais Martins de Lima ◽  
Suely Kunimi Kubo Ariga ◽  
Hermes Vieira Barbeiro ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Peripheral Blood ◽  
World Health ◽  
Control Group ◽  
Pyrin Domain ◽  
Peripheral Blood Gene Expression ◽  
Severe Group ◽  
Health Organization ◽  
The Impact

AbstractThe role of innate immunity in COVID-19 is not completely understood. Therefore, this study explored the impact of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection on the expression of Pattern Recognition Receptors (PRRs) in peripheral blood cells and their correlated cytokines. Seventy-nine patients with severe COVID-19 on admission, according to World Health Organization (WHO) classification, were divided into two groups: patients who needed mechanical ventilation and/or deceased (SEVERE, n = 50) and patients who used supplementary oxygen but not mechanical ventilation and survived (MILD, n = 29); a control group (CONTROL, n = 17) was also enrolled. In the peripheral blood, gene expression (mRNA) of Toll-like receptors (TLRs) 3, 4, 7, 8, and 9, retinoic-acid inducible gene I (RIGI), NOD-like receptor family pyrin domain containing 3 (NLRP3), interferon alpha (IFN-α), interferon beta (IFN-β), interferon gamma (IFN-γ), interferon lambda (IFN-λ), pro-interleukin(IL)-1β (pro-IL-1β), and IL-18 was determined on admission, between 5–9 days, and between 10–15 days. Circulating cytokines in plasma were also measured. When compared to the COVID-19 MILD group, the COVID-19 SEVERE group had lower expression of TLR3 and overexpression of TLR4.

scholarly journals Influenza With an Infiltrate: Investigating the New Community-Acquired Pneumonia Guidelines

2020 ◽  
Vol 41 (S1) ◽  
pp. s302-s302
Author(s):  
Amanda Barner ◽  
Lou Ann Bruno-Murtha
Keyword(s):  
Demographic Data ◽  
Retrospective Chart Review ◽  
Vaccination Rate ◽  
Community Acquired Pneumonia ◽  
Teaching Hospitals ◽  
Antibiotic Prescribing ◽  
Supporting Evidence ◽  
Radiographic Findings ◽  
Significant Difference ◽  
The Impact

Background: The Infectious Diseases Society of America released updated community-acquired pneumonia (CAP) guidelines in October 2019. One of the recommendations, with a low quality of supporting evidence, is the standard administration of antibiotics in adult patients with influenza and radiographic evidence of pneumonia. Procalcitonin (PCT) is not endorsed as a strategy to withhold antibiotic therapy, but it could be used to de-escalate appropriate patients after 48–72 hours. Radiographic findings are not indicative of the etiology of pneumonia. Prescribing antibiotics for all influenza-positive patients with an infiltrate has significant implications for stewardship. Therefore, we reviewed hospitalized, influenza-positive patients at our institution during the 2018–2019 season, and we sought to assess the impact of an abnormal chest x-ray (CXR) and PCT on antibiotic prescribing and outcomes. Methods: We conducted a retrospective chart review of all influenza-positive admissions at 2 urban, community-based, teaching hospitals. Demographic data, vaccination status, PCT levels, CXR findings, and treatment regimens were reviewed. The primary outcome was the difference in receipt of antibiotics between patients with a negative (<0.25 ng/mL) and positive PCT. Secondary outcomes included the impact of CXR result on antibiotic prescribing, duration, 30-day readmission, and 90-day mortality. Results: We reviewed the medical records of 117 patients; 43 (36.7%) received antibiotics. The vaccination rate was 36.7%. Also, 11% of patients required intensive care unit (ICU) admission and 84% received antibiotics. Moreover, 109 patients had a CXR: 61 (55.9%) were negative, 29 (26.6%) indeterminate, and 19 (17.4%) positive per radiologist interpretation. Patients with a positive PCT (OR, 12.7; 95% CI, 3.43–60.98; P < .0007) and an abnormal CXR (OR, 7.4; 95% CI, 2.9–20.1; P = .000003) were more likely to receive antibiotics. There was no significant difference in 30-day readmission (11.6% vs 13.5%; OR, 0.89; 95% CI, 0.21–3.08; P = 1) and 90-day mortality (11.6% vs 5.4%; OR, 2.37; 95% CI, 0.48–12.75; P = .28) between those that received antibiotics and those that did not, respectively. Furthermore, 30 patients (62.5%) with an abnormal CXR received antibiotics and 21 (43.7%) had negative PCT. There was no difference in 30-day readmission or 90-day mortality between those that did and did not receive antibiotics. Conclusions: Utilization of PCT allowed selective prescribing of antibiotics without impacting readmission or mortality. Antibiotics should be initiated for critically ill patients and based on clinical judgement, rather than for all influenza-positive patients with CXR abnormalities.Funding: NoneDisclosures: None

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