Increased incidence of adult pneumococcal pneumonia during school holiday periods

Child contact is a recognised risk factor for adult pneumococcal disease. Peaks in invasive pneumococcal disease incidence observed during winter holidays may be related to changes in social dynamics. This analysis was conducted to examine adult pneumococcal community-acquired pneumonia (CAP) incidence during school holiday periods.Between September 2008 and 2013, consecutive adults admitted to hospitals covering the Greater Nottingham area with a diagnosis of CAP were studied. Pneumococcal pneumonia was detected using culture and antigen detection methods.Of 2221 adults studied, 575 (25.9%) were admitted during school holidays and 643 (29.0%) had pneumococcal CAP. CAP of pneumococcal aetiology was significantly more likely in adults admitted during school holidays compared to term time (35.3% versus 26.7%; adjusted OR 1.38, 95% CI 1.11–1.72, p=0.004). Over the 5-year period, the age-adjusted incidence of hospitalised pneumococcal CAP was higher during school holidays compared to term time (incident rate ratio 1.35, 95% CI 1.14–1.60, p<0.001); there was no difference in rates of all-cause CAP or non-pneumococcal CAP. Reported child contact was higher in individuals with pneumococcal CAP admitted during school holidays compared to term time (42.0% versus 33.7%, OR 1.43, 95% CI 1.00–2.03, p=0.046).Further study of transmission dynamics in relation to these findings and to identify appropriate intervention strategies is warranted.

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Pneumococcal Pneumonia and Invasive Pneumococcal Disease in Those 65 and Older: Rates of Detection, Risk Factors, Vaccine Effectiveness, Hospitalisation and Mortality

Geriatrics ◽

10.3390/geriatrics6010013 ◽

2021 ◽

Vol 6 (1) ◽

pp. 13

Author(s):

Roger E. Thomas

Keyword(s):

Risk Factors ◽

Nursing Home ◽

Invasive Pneumococcal Disease ◽

Disease Transmission ◽

Pneumococcal Disease ◽

Pneumococcal Pneumonia ◽

Clinical Symptoms ◽

Disease Incidence ◽

Family Members ◽

Vaccination Rates

Pneumococcal pneumonia (PP) and invasive pneumococcal disease (IPD) are important causes of morbidity and mortality in seniors worldwide. Incidence rates and serious outcomes worsen with increasing frailty, numbers of risk factors and decreasing immune competence with increasing age. Literature reviews in Medline and Embase were performed for pneumococcal disease incidence, risk factors, vaccination rates and effectiveness in the elderly. The introduction of protein-conjugated pneumoccal vaccines (PCV) for children markedly reduced IPD and PP in seniors, but serotypes not included in vaccines and with previously low levels increased. Pneumococcal polysaccharide (PPV23) vaccination does not change nasal and pharyngeal carriage rates. Pneumococcal and influenza vaccination rates in seniors are below guideline levels, especially in older seniors and nursing home staff. Pneumococcal and influenza carriage and vaccination rates of family members, nursing home health care workers and other contacts are unknown. National vaccination programmes are effective in increasing vaccination rates. Detection of IPD and PP initially depend on clinical symptoms and new chest X ray infiltrates and then varies according to the population and laboratory tests used. To understand how seniors and especially older seniors acquire PP and IPD data are needed on pneumococcal disease and carriage rates in family members, carers and contacts. Nursing homes need reconfiguring into small units with air ventilation externally from all rooms to minimise respiratory disease transmission and dedicated staff for each unit to minimise transmision of infectious diseaases.

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Pneumococcal pneumonia and invasive pneumococcal disease: immunopathogenesis and diagnosis

Pneumologia ◽

10.2478/pneum-2019-0009 ◽

2019 ◽

Vol 68 (1) ◽

pp. 8-14

Author(s):

Gina Amanda ◽

Dianiati Kusumo Sutoyo ◽

Erlina Burhan

Keyword(s):

Immune System ◽

Invasive Pneumococcal Disease ◽

Pneumococcal Disease ◽

Pneumococcal Pneumonia ◽

Bacterial Load ◽

Adaptive Immune System ◽

Signs And Symptoms ◽

Community Acquired Pneumonia ◽

High Bacterial Load ◽

Droplet Nuclei

Abstract Streptococcus pneumoniae is the most common aetiology of community-acquired pneumonia (CAP). It has many virulence factors, the most important being a polysaccharide capsule (Cps). There are 97 different serotypes of pneumococcal based on Cps which include both colonization and invasive serotypes. Pneumococcal pneumonia may exist as a result of either aspiration of bacteria in the nasopharynx or inhalation of droplet nuclei which contains bacteria until they reach the lower respiratory tract. This condition will activate both innate and adaptive immune system. The diagnosis of pneumococcal pneumonia is established in a patient who has the signs and symptoms of pneumonia, accompanied by the detection of S. pneumoniae in microbiology examination. Pneumococcus may also penetrate into a normally sterile site such as bloodstream, meninges, and pleural cavity, and infection of pneumococcus in those sites are defined as an invasive pneumococcal disease (IPD). High bacterial load, dysfunction of the immune system, and co-colonization of another microorganism may also lead to IPD.

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The Relative Incident Rate Ratio Effect Size for Count-Based Impact Evaluations: When an Odds Ratio is Not an Odds Ratio

Journal of Quantitative Criminology ◽

10.1007/s10940-021-09494-w ◽

2021 ◽

Cited By ~ 2

Author(s):

David B. Wilson

Keyword(s):

Effect Size ◽

Odds Ratio ◽

Rate Ratio ◽

Ratio Effect ◽

Incident Rate Ratio ◽

Incident Rate

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Clinical Features and Outcomes of Community-Acquired Pneumonia Caused by Haemophilus Influenza

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa622 ◽

2021 ◽

Vol 8 (4) ◽

Author(s):

Saeed Shoar ◽

Fernando H Centeno ◽

Daniel M Musher

Keyword(s):

Clinical Features ◽

Alcohol Use Disorder ◽

Pneumococcal Pneumonia ◽

Severe Infection ◽

Clinical Findings ◽

Community Acquired Pneumonia ◽

Equal Frequency ◽

Haemophilus Influenza ◽

Radiologic Findings ◽

Viral Coinfection

Abstract Background Long regarded as the second most common cause of community-acquired pneumonia (CAP), Haemophilus influenzae has recently been identified with almost equal frequency as pneumococcus in patients hospitalized for CAP. The literature lacks a detailed description of the presentation, clinical features, laboratory and radiologic findings, and outcomes in Haemophilus pneumonia. Methods During 2 prospective studies of patients hospitalized for CAP, we identified 33 patients with Haemophilus pneumonia. In order to provide context, we compared clinical findings in these patients with findings in 36 patients with pneumococcal pneumonia identified during the same period. We included and analyzed separately data from patients with viral coinfection. Patients with coinfection by other bacteria were excluded. Results Haemophilus pneumonia occurred in older adults who had underlying chronic lung disease, cardiac conditions, and alcohol use disorder, the same population at risk for pneumococcal pneumonia. However, in contrast to pneumococcal pneumonia, patients with Haemophilus pneumonia had less severe infection as shown by absence of septic shock on admission, less confusion, fewer cases of leukopenia or extreme leukocytosis, and no deaths at 30 days. Viral coinfection greatly increased the severity of Haemophilus, but not pneumococcal pneumonia. Conclusions We present the first thorough description of Haemophilus pneumonia, show that it is less severe than pneumococcal pneumonia, and document that viral coinfection greatly increases its severity. These distinctions are lost when the label CAP is liberally applied to all patients who come to the hospital from the community for pneumonia.

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1381. Rotavirus Gastroenteritis among older adults: discussion based on a systematic literature review

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1563 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S700-S701

Author(s):

Cristina Carias ◽

Susanne Hartwig ◽

M Nabi Kanibir ◽

Ya-Ting Chen

Keyword(s):

Older Adults ◽

High Risk ◽

Acute Gastroenteritis ◽

Rate Ratio ◽

Rotavirus Gastroenteritis ◽

Incident Rate Ratio ◽

The Us ◽

Incident Rate ◽

The Uk ◽

Retrospective Database

Abstract Background While the burden of Rotavirus Gastroenteritis (RGE) is well recognized in young children, it is less so in older adults. However, older adults are also at high-risk of Acute Gastroenteritis (AGE) severe outcomes. In this review, we thus aimed to comprehensively assess RGE burden and vaccination impact in older individuals. Methods We performed a systematic literature review with PubMed and Scopus, from 2000 to 2019, using MESH and free-range terms. We included only studies that reported the incidence, and/or RV vaccination impact, in adults aged 60 and above and using regional specific data-sources. Results We analyzed 11 manuscripts for individuals aged 60 and above (Figure 1). Studies spanned Australia, Sweden, Netherlands, Canada (2), Germany (2), UK (2), and the US (2). Yearly inpatient RV incidence varied between 1.6 per 100,000 in Australia for those 65+ (retrospective database analyses, pre-vaccine); and 26 per 100,000 for those 85+ in Canada (modeling estimates for 2006-10, pre-vaccine). The incidence rate ratio for inpatient RGE between the post and pre-vaccine periods for those 65+ was 0.57 [95% CI: 0.10 – 3.15] in Canada, but 2.24 [95%CI: 1.78-2.83] in Australia, which may be due to increased testing for RV in the elderly post-vaccine. Reductions in the post-vaccination burden of RV and AGE among 60+ were reported in the UK (2 studies), and the US (2 studies) via retrospective database analyses In the UK, post-vaccine reductions in AGE health care-utilization were reported in the Emergency Department (21%), and outpatient centers (walk-in centers: 47%; general practice consultations: 36%). Retrospective database analyses documenting the incident rate ratio (IRR) of Rotavirus Gastroenteritis (RGE) and Acute Gastroenteritis (AGE) in older adults between the pre and post-vaccine period. Retrospective database analyses documenting the incident rate ratio (IRR) of Rotavirus Gastroenteritis (RGE) and Acute Gastroenteritis (AGE) in older adults between the pre and post-vaccine period. Conclusion While the burden of RGE mainly falls on young children, it also affects older adults. Retrospective database analyses reveal that, likely due to indirect vaccination benefits, increases in RV vaccination coverage have had an impact on lowering RGE, and AGE cases and healthcare utilization in older adults, a group at high-risk of severe outcomes for AGE. Disclosures Cristina Carias, PhD, Merck (Employee, Shareholder) Susanne Hartwig, n/a, MSD Vaccins (Employee) M.Nabi Kanibir, MD, Merck/MSD (Employee, Shareholder) Ya-Ting Chen, PhD, Merck & Co., Inc. (Employee, Shareholder)

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Comparative 4-year risk and type of hospital admission among homeless and housed emergency department attendees: longitudinal study of hospital records in England 2013–2018

BMJ Open ◽

10.1136/bmjopen-2021-049811 ◽

2021 ◽

Vol 11 (7) ◽

pp. e049811

Author(s):

Charlie Moss ◽

Matt Sutton ◽

Sudeh Cheraghi-Sohi ◽

Caroline Sanders ◽

Thomas Allen

Keyword(s):

Emergency Department ◽

Hospital Admissions ◽

Primary Diagnosis ◽

Secondary Outcome ◽

Emergency Admissions ◽

Incident Rate Ratio ◽

Chronic Angina ◽

Access To Primary Care ◽

Incident Rate ◽

Preventable Admissions

ObjectivesPeople experiencing homelessness are frequent users of secondary care. Currently, there is no study of potentially preventable admissions for homeless patients in England. We aim to estimate the number of potentially preventable hospital admissions for homeless patients and compare to housed patients with similar characteristics.DesignRetrospective matched cohort study.SettingHospitals in England.Participants16 161 homeless patients and 74 780 housed patients aged 16–75 years who attended an emergency department (ED) in England in 2013/2014, matched on the basis of age, sex, ED attended and primary diagnosis.Primary and secondary outcome measuresAnnual counts of admissions, emergency admissions, ambulatory care-sensitive (ACS) emergency admissions, acute ACS emergency admissions and chronic ACS emergency admissions over the following 4 years (2014/2015–2017/2018). We additionally compare the prevalence of specific ACS conditions for homeless and housed patients.ResultsMean admissions per 1000 patients per year were 470 for homeless patients and 230 for housed patients. Adjusted for confounders, annual admissions were 1.79 times higher (incident rate ratio (IRR)=1.79; 95% CI 1.69 to 1.90), emergency admissions 2.08 times higher (IRR=2.08; 95% CI 1.95 to 2.21) and ACS admissions 1.65 times higher (IRR=1.65; 95% CI 1.51 to 1.80), compared with housed patients. The effect was greater for acute (IRR=1.78; 95% CI 1.64 to 1.93) than chronic (IRR=1.45; 95% CI 1.27 to 1.66) ACS conditions. ACS conditions that were relatively more common for homeless patients were cellulitis, convulsions/epilepsy and chronic angina.ConclusionsHomeless patients use hospital services at higher rates than housed patients, particularly emergency admissions. ACS admissions of homeless patients are higher which suggests some admissions may be potentially preventable with improved access to primary care. However, these admissions comprise a small share of total admissions.

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When to use the new pneumococcal vaccine

Drug and Therapeutics Bulletin ◽

10.1136/dtb.28.8.31 ◽

1990 ◽

Vol 28 (8) ◽

pp. 31-32

Keyword(s):

United States ◽

Pneumococcal Vaccine ◽

Pneumococcal Disease ◽

Pneumococcal Pneumonia ◽

Pneumococcal Infection ◽

The Elderly ◽

The United States ◽

Cell Disease ◽

Large Groups ◽

Special Risk

Pneumococcal pneumonia probably affects about one in every thousand adults each year. Like other serious pneumococcal infection, it is more common and severe in the elderly, in those without a functional spleen (including patients with sickle-cell disease,1) and in patients with a variety of chronic diseases. In the United States a 23-valent pneumococcal vaccine was introduced in 1983, replacing a 14-valent vaccine; it is now recommended there for large groups of people.2 This newer 23-valent vaccine (Pneumovax-II - MSD) was licensed in Britain last May. Its use should be considered for those at special risk of pneumococcal disease.3–5

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The burden of hospitalisations for community-acquired pneumonia (CAP) and pneumococcal pneumonia in adults in Spain (2003–2007)

Vaccine ◽

10.1016/j.vaccine.2010.11.025 ◽

2011 ◽

Vol 29 (3) ◽

pp. 412-416 ◽

Cited By ~ 56

Author(s):

Ruth Gil-Prieto ◽

Laura García-García ◽

Alejandro Álvaro-Meca ◽

Cristina Méndez ◽

Ana García ◽

...

Keyword(s):

Pneumococcal Pneumonia ◽

Community Acquired Pneumonia

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Cost-effectiveness of adult pneumococcal conjugate vaccination in the Netherlands

European Respiratory Journal ◽

10.1183/13993003.00325-2015 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1407-1416 ◽

Cited By ~ 56

Author(s):

Marie-Josée J. Mangen ◽

Mark H. Rozenbaum ◽

Susanne M. Huijts ◽

Cornelis H. van Werkhoven ◽

Douwe F. Postma ◽

...

Keyword(s):

Cost Effectiveness ◽

High Risk ◽

The Netherlands ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Pneumococcal Disease ◽

Community Acquired Pneumonia ◽

Base Case ◽

Vaccination Strategies ◽

Vaccine Type

The Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA) demonstrated the efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) in preventing vaccine-type community-acquired pneumonia and vaccine-type invasive pneumococcal disease in elderly subjects. We examined the cost-effectiveness of PCV13 vaccination in the Netherlands.Using a Markov-type model, incremental cost-effectiveness ratios (ICER) of PCV13 vaccination in different age- and risk-groups for pneumococcal disease were evaluated using a societal perspective. Estimates of quality-adjusted life-years (QALYs), costs, vaccine efficacy and epidemiological data were based on the CAPiTA study and other prospective studies. The base-case was PCV13 vaccination of adults aged 65–74 years compared to no vaccination, assuming no net indirect effects in base-case due to paediatric 10-valent pneumococcal conjugate vaccine use. Analyses for age- and risk-group specific vaccination strategies and for different levels of hypothetical herd effects from a paediatric PCV programme were also conducted.The ICER for base-case was €8650 per QALY (95% CI 5750–17 100). Vaccination of high-risk individuals aged 65–74 years was cost-saving and extension to medium-risk individuals aged 65–74 years yielded an ICER of €2900. Further extension to include medium- and high-risk individuals aged ≥18 years yielded an ICER of €3100.PCV13 vaccination is highly cost-effective in the Netherlands. The transferability of our results to other countries depends upon vaccination strategies already implemented in those countries.

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