Incidence, aetiology, and enviromental risk factors of community-acquired pneumonia requiring hospitalization in China: a 3-year, prospective, age-stratified, multi-centre case-control study

Background Community-acquired pneumonia (CAP) is a leading infectious cause of hospitalisation and death worldwide. The knowledge about the incidence and aetiology of CAP in China was fragmented. Methods A multicenter study performed at four hospitals in four regions in China and clinical samples from CAP patients were collected and used for pathogen identification from July 2016 to June 2019. Results A total of 1,674 patients were enrolled and the average annual incidence of hospitalized CAP was 18.7 cases per 10,000 people (95% confidence interval 18.5–19.0). The most common viral and bacterial agents found in patients were respiratory syncytial virus (19.2%) and Streptococcus pneumoniae (9.3%). The co-infections percentage was 13.8%. Pathogen distribution displayed variations within age groups, and seasonal and regional differences. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was not detected. Respiratory virus detection was significantly positively correlated with air pollutants, including PM2.5, PM10, NO2 and SO2; and significantly negatively correlated with ambient temperature and O3 content; bacteria detection was opposite. Conclusion The hospitalized CAP incidence in China was higher than previously known. CAP etiology showed differences in age, seasons, regions, and respiratory viruses were detected at a higher rate than bacterial infection overall. Air pollutants and temperature have influence on the detection of pathogens.

Incidence of spontaneous intracranial hypotension in a community. Beverly Hills, California, 2006–2020

Background Spontaneous intracranial hypotension is diagnosed with an increasing frequency, but epidemiologic data are scarce. The aim of this study was to determine the incidence rate of spontaneous intracranial hypotension in a defined population. Methods Using a prospectively maintained registry, all patients with spontaneous intracranial hypotension residing in Beverly Hills, California, evaluated at our Medical Center between 2006 and 2020 were identified in this population-based incidence study. Our Medical Center is a quaternary referral center for spontaneous intracranial hypotension and is located within 1.5 miles from downtown Beverly Hills. Results A total of 19 patients with spontaneous intracranial hypotension were identified. There were 12 women and seven men with a mean age of 54.5 years (range, 28 to 88 years). The average annual incidence rate for all ages was 3.7 per 100,000 population (95% confidence interval [CI]: 2.0 to 5.3), 4.3 per 100,000 for women (95% CI, 1.9 to 6.7) and 2.9 per 100,000 population for men (95% CI, 0.8 to 5.1). Conclusion This study, for the first time, provides incidence rates for spontaneous intracranial hypotension in a defined population.

Epidemiological and clinical characteristics of melioidosis caused by gentamicin-susceptible Burkholderia pseudomallei in Sarawak, Malaysia

Background Burkholderia pseudomallei, the causative agent of melioidosis, is intrinsically resistant to a broad range of antibiotics, including aminoglycosides. In Sarawak, Malaysia, a high proportion of melioidosis cases are caused by gentamicin-susceptible isolates. There are limited epidemiological and clinical data on these infections. Methods We conducted a retrospective study of culture-confirmed melioidosis among adults admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2016. Results One-hundred and forty-eight adults with culture-confirmed melioidosis were identified. Of 129 (87%) tested, 84 (65%) had gentamicin-susceptible B. pseudomallei. The average annual incidence of melioidosis was 12·3 per 100,000 population, with marked variation between districts ranging from 5·8-29·3 per 100,000 population. Rural districts had higher incidences of melioidosis and overwhelmingly larger proportions of gentamicin-susceptible B. pseudomallei infection. Significantly more patients with gentamicin-susceptible infection had no identified risk factors, with diabetes less frequently present in this group. Ninety-eight percent had acute presentations. Pneumonia, reported in 71%, was the most common presentation. Splenic abscesses were found in 54% of those imaged. Bacteremia was present in 88%; septic shock occurred in 47%. Forty-five (35%) patients died. No differences in clinical, laboratory, or outcome characteristics were noted between gentamicin-susceptible and gentamicin-resistant infections. Conclusions Gentamicin-susceptible B. pseudomallei infections are common in Sarawak and dominate in the high incidence rural interior regions. Clinical manifestations and outcomes are the same as for gentamicin-resistant B. pseudomallei infections. Further studies are required to determine if all gentamicin-susceptible B. pseudomallei in Sarawak are clonal and to ascertain their environmental drivers and niches.

Multiple myeloma in Armenia during the period 2006–2018: facts and discussion

Background It is known that one of the reasons for the increased incidence of hematological malignancies is caused by the growth of multiple myeloma (MM). Worldwide, approximately 159,985 new cases of MM are diagnosed representing 0.9% of all cancer diagnoses and 106,105 patients will die from MM accounting for 1.1% of all cancer deaths per year. Despite significant advances in the MM treatment the mortality rates are still high. The presented study is the first accurate epidemiological study of ММ in Armenia for the period of 2006–2018. Methods The initial data for this retrospective cohort survey were derived from ambulance cards, hospitalization journals, and clinical data from the Registry of Blood Diseases at the Yeolyan Hematology Center. Results Data analysis showed that during 2006–2018 the average annual incidence for the MM was 1.2 per 100,000 population. A significant increase was observed in 2018 compared to 2006, 1.9 vs. 0.7 per 100,000 population. Interestingly, there were no sex differences in the overall MM incidence during the study period. According to the received data, during the period of the 2006–2009 and 2014–2018 the 1-year survival rate for both sexes decreased dramatically from 83 to 64.1% at age group 60 years and below and from 78.5 to 68.1% in group 60 years and over. The 1-year overall survival (OS) for both sexes decreased by 18.9% for patients (≤60 age group) and 10.4% (> 60 age group) in the period of 2006–2009 to the period of 2014–2018. Conclusions The incidence rates for the MM increased during the analyzed period. Our study showed that males and females in the age group 60 years and below had better 5-year overall survival compared to elder ones and females have better survival.

Descriptive epidemiology of measles cases in Bauchi State, 2013–2018

Background Measles accounts for high morbidity and mortality in children, especially in developing countries. In 2017, about 11,190 measles cases were recorded in Nigeria, including Bauchi State. The aim of this study was to describe the trend and burden of measles in Bauchi State, Nigeria. Method We analyzed secondary data of measles cases extracted from the Measles Surveillance data system in Bauchi State from January 2013 to June 2018. The variables extracted included age, sex, doses of vaccination, case location and outcome. Data were analyzed using descriptive statistics, logistic regression, and multiplicative time series model (α = 0.05). Results A total of 4935 suspected measles cases with an average annual incidence rate of 15.3 per 100,000 population and 57 deaths (Case Fatality Rate, CFR: 1.15%) were reported. Among the reported cases, 294 (6%;) were laboratory-confirmed, while clinically compatible and epi-linked cases were 402 (8%) and 3879 (70%), respectively. Of the 4935 measles cases, 2576 (52%) were males, 440 (9%) were under 1 year of age, and 3289 (67%) were between 1 and 4 years. The average annual incidence rate among the 1–4 year age-group was 70.3 per 100,000 population. The incidence rate was lowest in 2018 with 2.1 per 100,000 and highest in 2015 with 26.2 per 100,000 population. The measles cases variation index per quarter was highest in quarter 1 (198.86), followed by quarter 2 (62.21) and least in quarter 4 (10.37) of every year. Only 889 (18%) of the measles cases received at least one dose of measles vaccine, 2701 (54.7%) had no history of measles vaccination while 1346 (27.3%) had unknown vaccination status. The fatality of measles in Bauchi State were significantly associated with being under 5 years (AOR = 5.58; 95%CI: 2.19–14.22) and not having at least a dose of MCV (OR = 7.14; 95%CI: 3.70–14.29). Conclusion Measles burden remains high in Bauchi State despite a decrease in its incidence over the study years. Most of the cases occurred in the first quarter of every year. Improved routine measles surveillance for prompt case management could reduce the burden of the disease in Bauchi State.

Epidemiological Characteristics of Rubella in Beijing Haidian District of China, 2005 - 2020

Background: This study aimed to investigate the epidemiological characteristics of rubella in Beijing Haidian District of China, from 2005 to 2020, providing scientific basis for controlling the prevalence of rubella and the congenital rubella syndrome (CRS). Methods: Data were collected via the legal infectious disease report cards from medical institutions in Beijing Haidian District during 2005 to 2020. The descriptive epidemiological methods plus statistic analysis were used to analyze the distribution of rubella in terms of population, time and region. Results: In total, there were 994 cases of rubella in Beijing Haidian District, with an average annual incidence of 1.81/100,000 population. The majority of patients were at the age from 15 to 29 years old, accounting for 63.4%. And the sex ratio of male-to-female was 1.45:1. The rubella had a feature of spatial aggregation and appeared in all the regions in Haidian District. In 2007, Haidian District was hitted by rubella with the highest incidence up to 8.37/100,000, in the past 16 years. The peak incident of rubella was in May of that year, accounting for 74.8%. The majority of rubella patients were students and employees (70.1%) mainly due to the gathering. According to Joinpoint regression model, rubella would still exist in the next three years with 2-5 new cases per year. Conclusions: The number of rubella in Haidian District showed a downshift trend from 2008 to 2014 and then a sporadic distribution till 2020. Yet this disease was not completely eliminated, it is quite impending to improve the awareness of rubella and their health literacy mentally and physically in the whole population by means of the policy issuing from government.

MO374DISCLOSURE OF THE RESULTS OF A 40-YEARS RESEARCH OF UPPER TRACT UROTHELILAL CANCER AND BALKAN ENDEMIC NEPHROPATHY

Background and Aims The general significance of Balkan endemic nephropathy (BEN) is the association with upper tract urtohelial cancer (UTUC). In published papers studying these two entities, there is large difference between the obtained results. By UTUC research, obtained results are the most diverse in relation to the period and region of research. The aim of the research is to show the discrepancy between the results of the research of UTUC of Jablanica district in relation to the observation period and the type of settlement. Method The research period lasted from 1978-2017. During the analysis of the frequency of UTUC, we used the operative material of Urology Department, Health Care Center, Leskovac , and Urology Clinic, Clinical Center, Nis, Clinical Center, Nis. For practical reasons, this period was devided into two periods, the first (1978-1997) and the second (1998-2017). In order to make classification of settlements we used the data of the Institute of Nephrology and Hemodialysis in Nis (A-endemic regions, B-hypo-endemic, C-non-endemic urban, D-non-endemic rural regions). Data on the total number of Jablanica region population were obtained on the basis of the censuses from 1991 and 2011. The average annual incidence rate (AAIR) was calculated per 100 000 people. Finally, we jointly observed groups A and B (endemic areas) C and D (non-endemic areas) for UTUC. Results The average annual incidence rate (AAIR) in the period of 1978-2017 in endemic settlements of Jablanica region was (11.82), while in hypo-endemic was (4.49) and non-endemic (0.83). The data demonstrated that inhabitants of endemic settlements has 14.24 times higher UTUC frequency in comparison to non-endemic settlements in time span of research. Our research in Jablanica region also demonstrated unexpectedly high frequency of on UTUC not only in endemic settlements with BEN (Kutles village- 1 tumor per 99.63 and AAIR 40.15), but also in some of the non-endemic area (Brejanovac village-1 tumour per 98.75 people and AAIR of 40.50; Rudare village-1 tumour per 139.50 people and AAIR of 28.67; Bogojevce village-1 tumour per 187.63 people and AAIR 21.32). This occurrence of UTUC frequency in some non-endemic settlements refers to the first observed period until no occurrence was recorded in the second observed period. There is a higher UTUC frequency in endemic settlements of 11.37 in the first period (A- AAIR 21.95), while in hypo-endemic (B-AAIR 11.82) is 3.64 higher incedence. In non-endemic settlements (C,D-AAIR 1.09) there is 1.63 higher incidence in comparison to the second period. Observing the periods, there is a higher UTUC frequency of five times in endemic settlements (A, B) of Jablanica region in the first period comparing to the second. The linear trend of UTUC in the 40-year period demonstrates a slow decrease (y= -0.0797x + 4.2846; r2 = 0.2028) in Jablanica region. In the same observed period, linear trend of BEN is in corelation of decreased linear trend of UTUC (y= -0.164x+6.0669; r2 =0.748). Conclusion A forty-year study of UTUC in the Jablanica region showed a discrepancy between the results in relation to the observation period and the type of settlement, which coincides with the generally accepted view that epidemiology is the most fascinating part of BEN. In endemic settlements, in the second observed period, the frequency of UTUC was registered five times lower than in the first, which coincides with the decrease in the frequency of BEN in these settlements.

Epidemiology of Concussion in the National Football League, 2015-2019

Background: Concussion in American football, and specifically the National Football League (NFL) is a major area of interest and key focus for injury prevention. Complete and accurate characterization of when, how, and to whom these injuries occur can facilitate injury reduction efforts. Existing studies of concussion in the NFL use publicly available data, potentially limiting data quality and the inferences that can be made. Hypothesis: Concussion incidence in the NFL decreased across the 2015-2019 seasons. Study Design: Descriptive epidemiology study. Level of Evidence: Level 4. Methods: Concussion incidence, including counts, one-season risk, and rates per game and player-plays, among active NFL players from 2015 to 2019 is described by year, season, play type, and roster position. Results: A total 1302 concussions were identified from 2015 to 2019 among 1004 players. Of these, 80% occurred in NFL games. The average annual incidence of in-season game concussions changed over the study period, from 230.7 per season (2015-2017) to 177.0 per season (2018-2019); this represented a 23% decrease in game settings ( P < 0.01). Practice concussions fluctuated across the years of the study from 38 to 67 per season (average = 50.8/season). There were 70.6 concussions per 100 preseason games, which was slightly higher than the regular season rate per game of 61.7. Overall, there were 790 regular season game concussions across 4,657,243 player-plays and 114,428 player-games during the 5-year study. In regular season games, the majority of concussions were sustained on running and passing plays (n = 119/season), and the highest average rate per play occurred on kickoffs (0.69/100 plays). Defensive secondary (cornerbacks, safeties, and generic defensive backs) and offensive line incurred the most concussions, and the highest rates of concussion were among tight ends and wide receivers. Conclusion and Relevance: Concussions in the NFL are a key focus for player safety. Concussion reduction strategies were implemented before 2018, after which there was a sustained 2-year decrease in concussion incidence, providing a new benchmark from which to work toward further injury reduction.

Gallbladder stone incidence and prevalence in Germany: a population-based study

Background We aimed to determine the prevalence and incidence of gallbladder stones in a random population-based collective in Germany. Methods We determined the prevalence and incidence rates of gallbladder stones in a random population sample of 1909 individuals from the Echinococcus-multilocularis in Leutkirch (EMIL) study in 2002 and 380 individuals in a follow-up analysis in the year 2013. The sonographic analysis was performed with a Philipps HDI 5000 (2002) and IU 22 (2013) (Netherlands) transducer 1–5 MHz. Statistical analysis was performed using SAS Version 9.4. Results The prevalence of gallbladder stones was 3.8 % (69/1909) in 2002 and 10.8 % (41/380) in 2013. In 2013, the gallbladder stone prevalence was 15.1 % (26/172) in women, compared to 7.2 % (15/208) in men. No gallbladder stones were found in participants in the 18–30 or 31–40 age groups. The average annual incidence was 1.03 % in the 41–50 age group, 0.79 % in the 51–65 age group, and 0.63 % in the > 65 age group. The annual incidence was higher among women (1.04 %) than men (0.53 %). The age-associated annual incidence rates for women and men were 1.93 % and 0.5 % in the 41–50 age group, 0.8 % and 0.78 % in the 51–65 age group, and 1.06 % and 0.30 % in the > 65 age group. Conclusion For the investigated German collective from 2002 to 2013, the average annual incidence of gallbladder stones was 0.75 %, with a higher incidence rate among women. These results are consistent with data from comparable international studies.

Descriptive epidemiology and survival analysis of acromegaly in Korea

Acromegaly is a rare, slowly progressive disease. Its mechanism is not fully understood, and epidemiological research on Korean patients with acromegaly is scarce. To determine the incidence and prevalence of acromegaly and assess the comorbidities and survival benefits based on treatment options. This nationwide population-based cohort study was conducted using data of the Korean Health Insurance Review and Assessment claims database to evaluate the incidence of newly diagnosed acromegaly cases during 2013–2017. During the 5-year period, 1,093 patients were newly diagnosed with acromegaly. The average annual incidence was 4.2 cases per million per year, and the prevalence was 32.1 cases per million during this period. The incidence of hypertension was low after medical treatment (hazard ratio 0.257, 95% confidence interval: 0.082–0.808, P = 0.0201), but the incidence of diabetes showed no significant difference across treatment modalities. Over a period of 6 years since diagnosis, we found that patients treated for acromegaly had a significantly higher survival rate than those untreated (P = 0.0003). The annual incidence rate of Korean patients with acromegaly was similar to that reported in previous studies. Using nationwide population data, our study emphasized the importance of treatment in acromegaly patients.