Background

Pneumococcal disease (PD) case-fatality rate (CFR) in Costa Rica has being reported higher (8-30%) than in literature (3-22%).

Methods

Descriptive study of adult cases with culture-positive PD seeking care at two tertiary care hospitals in Costa Rica between 2014-2018. Information on demographics, clinical characteristics and outcomes was analyzed for each case.

Results

282 culture-positive PD cases were included. CFR is consistently higher in all risk groups among ≥ 60 y/o patients OR 2.31 [IC95 1.38-3.89].

Log-rank analysis showed an unequal 30-day mortality in adults ≥ 60 y/o (p=0.012) but no differences in risk related groups (p=0.91).

Conclusions

PD CFR vary between age and risk groups in Costa Rica. Across all risk groups, elder adults have the most risk of dying following PD. There is a similar mortality rate among all ages high-risk patients and at-risk patients. Prevention strategies to reduce the ongoing burden of mortality from PD are needed, especially for elderly patients.

Background

In the UK adults aged 65+ years and those at increased risk of pneumococcal infection are offered a single dose of the 23-valent pneumococcal polysaccharide vaccine (PPV23). PCV-13 is currently used for routine infant immunisation and severely immunocompromised individuals but has an adult indication, and next generation higher valency PCVs (PCV-15 and PCV-20) are anticipated to shortly become available for use in adults.

Methods

Recent peer reviewed publications describing the contemporary pneumococcal disease burden in UK adults were identified. The serotype distribution reflected by PCV-13, PCV-15 and PCV-20 was determined.

Results

The burden of adult pneumococcal disease in the UK remains substantial with no discernible impact of PPV23 at the population level. In 2016/17 the proportion of PCV-13, PCV-15 and PCV-20 IPD in adults aged 65+ years was 21%, 32% and 63% respectively. Between 2013/14 and 2017/18 the average proportion of PCV-13, PCV-15 and PCV-20 pneumococcal pneumonia in adults aged 16+ years was 35%, 40% and 66% respectively (36%, 39% and 64% in 2017/18).

Conclusions

Vaccinating UK adults with PCV-13 could address a significant proportion of the contemporary adult pneumococcal disease burden. Higher valency PCVs provide increased coverage of serotypes currently causing adult disease, with PCV-20 potentially addressing ~65% of the burden.

Background

The annual SAVE study was initiated in Canada in 2011 after PCV-13 was introduced. The study aims to detect antimicrobial susceptibility changes, overall and by serotype, in S. pneumoniae (SPN).

Methods

In collaboration between CARA, selected public health laboratories and PHAC-NML, the SAVE study collected 11044 invasive isolates of SPN from 2011 to 2018. Serotyping was performed using the Quellung reaction. Susceptibility testing was performed using CLSI methods.

Results

In 2018, 1878 SPN were collected as part of the SAVE study. The susceptibility results of the 10 most common serotypes in 2018 are shown below.

MDR was noted in 24 serotypes with the highest rates in 14 (60%), 15A (55.8%), 23F (50%), 6A/B (30/33.3%) and 19A (25%). Of the 120 MDR isolates identified in 2018, the most commonly observed MDR pattern was resistance to CLR, clindamycin, chloramphenicol and DOX (n=34). The rate of MDR SPN in 2018 was 6.5%, representing a decrease from the study high of 8.5% in 2011 but an increase from the 2016 rate of 3.9%.

Conclusions

Ongoing changes in the epidemiology and susceptibility patterns in SPN in Canada were observed.

Background

Mortality due to S. pneumoniae is particularly high amongst children. We assessed the association of serotype with mortality in ages below 5 years in invasive pneumococcal disease (IPD) in the post-vaccine era in South Africa (SA).

Methods

We conducted surveillance for laboratory-confirmed IPD at 28 hospitals in SA during 2012-2018. We used multivariable logistic regression to compare the association of serotype with in-hospital outcome.

Results

Of 825 IPD cases with pneumococcal serotype, age and outcome data, 212(26%) died (31%(79/254) with meningitis, 21% (109/513) with bacteremia and 41%(24/58) from other invasive disease). Overall among IPD, compared to patients infected with serotype 8 (the most common serotype identified) and after adjusting for age, HIV status and specimen type, those with serotypes 15A (OR:5.0, 95%CI:2.0-12.1), 6A (OR:4.8, 95%CI:1.8-12.9), 19F (OR:3.3, 95%CI:1.3-8.6), 22F (OR:6.8, 95%CI:1.5-31.7), 17F (OR:3.8, 95%CI:1.2-12.2), 11A (OR:6.0, 95%CI:1.2-28.7), 13 (OR:4.1, 95%CI:1.2-14.7) and 35B (OR:2.6, 95%CI:1.1-6.2) were more likely to die. In meningitis cases, those with serotype 6A (OR:13.1, 95%CI:1.2-139.5) were more likely to die compared to serotype 8.

Conclusions

In the vaccine era in children aged <5 years, of the serotypes associated with increased mortality, the majority (15A, 22F, 17F, 11A, 13, 35B) are not included in the current conjugate vaccines.

Background

Pneumococcal serotypes 19F and 1 were associated with mortality amongst adults and adolescents in the pre-vaccine era in South Africa (SA). We assessed the association of serotype with mortality in individuals aged ≥5 years with invasive pneumococcal disease (IPD) during the vaccine era.

Methods

We conducted surveillance for laboratory-confirmed IPD at 28 hospitals in SA during 2012-2018. We used multivariable logistic regression to compare the association of serotype with in-hospital outcome.

Results

Of 3453 IPD cases with available serotype, age and outcome information, 1158 (34%) died (47% (458/970) with meningitis, 29% (643/2219) with bacteremia and 22% (57/264) with other invasive disease). Overall among IPD, compared to patients infected with serotype 8 (the most common serotype identified) and after adjusting for age, HIV status and specimen type, those with serotype 15B/C (OR:2.01, 95%CI: 1.16-3.48) were more likely to die. When restricting to meningitis cases, patients with serotype 23A (OR:0.31, 95%CI:0.10-0.95) were less likely to die compared to patients with serotype 8.

Conclusions

In the post-vaccine era, in ages ≥5 years, serotype 15B/C is associated with increased mortality, however this serotype is not included in the currently available conjugate vaccines.

Background

Incidence of Invasive pneumococcal disease (IPD) depends on numerous factors, including vaccine undertake, geographic location, and serotype prevalence. There is limited data about the incidence of Streptococcus pneumoniae (Spn), serotype distribution, and clinical characteristics of adults hospitalized due to IPD in Colombia. Thus, this study will attempt to bridge this gap in the literature.

Methods

This is an observational, retrospective, citywide study conducted between 2012 and 2019 in Bogotá, Colombia. We analyzed, reported positive cases of IPD. Importantly, Bogotá represents approximately 75% of the Colombian population. Strains were isolated in each hospital and typified in a centralized laboratory. The objectives included assessment of Spn serotype distribution, clinical diagnosis, mortality, ICU admission, and need for mechanical ventilation.

Results

A total of 314 patients with IPD were included, 54.8% male. The leading cause of IPD was pneumonia (33%), followed by meningitis and sepsis. The most prevalent serotypes were 19A (13.1%) and 3 (12.4%). The overall hospital mortality was 30%. Moreover, 65.6% were admitted to the ICU, 44.9% required invasive mechanical ventilation, and 5.1% non- invasive mechanical ventilation.

Conclusions

Pneumococcal pneumonia continues to be the most prevalent cause of IPD. Serotypes 19A and 3 are the leading cause of IPD in Colombian adults.

Background

The number of deaths due to pneumococcal pneumonia (PP) in the United States (U.S.) is not well defined. The objectives of this study were to define mortality of PP in the city of Louisville, Kentucky and to estimate the number of deaths in hospitalized patients with PP in the U.S.

Methods

In hospitalized patients with community-acquired pneumonia (CAP), urinary antigen detection of 24 S. pneumoniae serotypes (UAD-24) was performed. This UAD-24 study was nested in a prospective population-based cohort study of all adult residents in Louisville, hospitalized with CAP from 6/1/14 to 5/31/16. Louisville PP mortality was evaluated early (during hospitalization and at 30-days after hospitalization) and late (6-months and 1-year after hospitalization) and US number of deaths were estimated.

Results

A total of 708 patients with PP were evaluated. PP mortality was 3.7% during hospitalization, 8.2% at 30-days, 17.6% at 6-months, and 25.4% at 1-year. Number of deaths in the U.S. were: 8,323 (95%CI:5,468-12,091) during hospitalization, 18,619 (95%CI:14,231-23,711) at 30-days, 39,807 (95%CI:33,506-46,502) at 6 months, and 57,626 (95%CI:50,130-64,940) at 1-year.

Conclusions

In hospitalized patients, PP is associated with significant early and late mortality. Approximately 1 out of 4 hospitalized adult patients with PP will die within 1-year.

Background

The Nordic countries have different pediatric PCV programmes. In 2017, Norway and Denmark were using PCV13, Sweden both PCV10 and PCV13 and Finland used PCV10. All programmes have demonstrated high effectiveness in children, but with different indirect effect among elderly.

Methods

The IPD incidence for the year 2017 in +65 years of age was evaluated together with serotype specific coverage of licensed vaccines and developmental pneumococcal conjugate vaccines (PCVs) using data from the ECDC.

Results

Table: IPD incidence per 100 000 (%) by vaccine serotypes in +65 population, 2017

Conclusions

There are major differences in the serotype distribution in IPD among elderly between the Nordic countries associated with the choice of PCV in the pediatric programme. A substantial amount of IPD amongst elderly can be addressed by direct vaccination.

Background

In Vietnam, the Invasive Bacterial Vaccine Preventable Diseases (IB-VPD) Surveillance network of World Health Organization which identifies major pathogens causing bacterial meningitis has been implemented since 2012. This program utilizes realtime PCR for detection of Streptococcus pneumoniae (Spn), Neisseria meningitidis (Nm) and Haemophilus influenzae (Hi) in children under 5 years of age suspected for bacterial meningitis. This work presents the positive rate and serotypes distribution of Spn from this program between 2018 and 2019.

Methods

540 cerebrospinal fluid (CSF) specimens of probable bacterial meningitis cases from 1 month to 59 months old were collected for identification of Spn, Nm and Hi by triplex direct rt-PCR. Positive samples for Spn were serotyped for 21 serotypes.

Results

Total positivity rate of three pathogens was 6.5%, among which Spn was predominant (94.3%, n= 33), following by Nm (5.7%, n=2), and there was no Hi detected. PCV13-types account for 94.0%, of which 6A/B was the most prevalent serotype (54.5%, n=18).

Conclusions

Spn was the most common cause of pediatric bacterial meningitis in Southern Vietnam from 2018-2019. Majority of serotypes found are included in pneumococcal conjugate vaccines, which are not yet introduced in the national immunization schedule in Vietnam.

Background

Streptococcus pneumoniae is a major cause of childhood morbidity and mortality, especially in low- and middle-income countries. Angola introduced the conjugated pneumococcal vaccine (PCV13) in 2013. Our objective was to study pneumococcal carriage and antibiotic resistance in unvaccinated children in Angola.

Methods

The study enrolled children in Luanda and Lunda Sul in November and December 2017. Nasopharyngeal samples were transported frozen in STGG medium to Sweden where bacteria were identified by optochin susceptibility. Pneumococci were serotyped by a multiplex PCR and the Quellung reaction. Antimicrobial susceptibility testing was done according to EUCAST.

Results

Of 940 children, 443 (47%) were females, and median age was 8 years (range 4-12 years). The carriage of pneumococci was 35% (332/940), and 45% (127/280) of strains exhibited PCV13-serotypes. Reduced sensitivity to penicillin was found in 39%, more commonly in vaccine-type than in non-vaccine-type pneumococci (50% vs 33%, p=0.003). Underweight children (BMI under 5th percentile) carried pneumococci more often than other children (44% vs 34%, p=0.013).

Conclusions

If implemented successfully PCV-13 may have a significant impact on pneumococcal disease in Angola. It may also prevent pneumococcal penicillin resistance. Our data may be used as an estimate of the pre-vaccine situation in Angola.

Background

Acute respiratory infections (ARIs) are one of the leading causes of child mortality worldwide. This study aimed to explore the care-seeking behaviors among under-five children in Bangladesh and identified factors associated with ARI and subsequent care-seeking behaviors.

Methods

The present study analyzed cross-sectional data from the 2004 to 2014 Bangladesh Demographic Health Survey. Bivariate analysis was performed to estimate the association between ARIs and associated care-seeking. A p-value of <0.05 was considered as the level of significance.

Results

A total of 10,147 ARI children aged < 5 years were included in the study. Factors such as education, birth order, household electricity, household source of drinking water, toilet facility, media exposure (radio), nutritional status (WHZ), household cooking fuel were found to be significantly associated with the utilization of healthcare for ARI. The family who had higher birth order, not electricity in their household had 1.16 (95% CI 1.03-1.30; P = 0.009) and 1.63 times (95% CI 1.43-1.86; P = <0.001) had less chance to receive care.

Conclusions

Public and private sector's actions to increase service accessibility for poorer households, equitable and efficient service distribution and interventions targeting households with low socio-economic status and lower education levels are recommended.

Background

Studies on community-acquired pneumonia (CAP) and pneumococcal pneumonia (PP) related to 13-valent pneumococcal conjugate vaccine (PCV13) introduction in Asia are scarce. This study aimed to investigate the epidemiological and microbiological determinants of CAP and PP after the introduction of PCV13 in Japan.

Methods

This observational population-based surveillance study included children aged ≤15 years, admitted to hospitals around Chiba City, Japan. Participants had bacterial pneumonia based on a positive blood or sputum culture for bacterial pathogens. Serotype and antibiotic-susceptibility testing of Streptococcus pneumoniae and Haemophilus influenzae isolates from patients with bacterial pneumonia were assessed.

Results

The CAP hospitalisation rate per 1000 child-years was 17.7, 14.3, and 9.7 in children aged <5 years and 1.18, 2.64, and 0.69 in children aged 5–15 years in 2008, 2012, and 2018, respectively. There was a 45% and 41% reduction in CAP hospitalisation rates, between the pre-PCV7 and PCV13 periods, respectively. Significant reductions occurred in the proportion of CAP due to PP and PCV13 serotypes. Conversely, no change occurred in the proportion of CAP caused by H. influenzae.

Conclusions

The incidence of CAP in children aged ≤15 years was significantly reduced after the introduction of PCV13 in Japan. Continuous surveillance is necessary to detect emerging PP serotypes.

Background

Acute bacterial meningitis caused by Streptococcus pneumoniae is an important pathology for public health because of its high morbidity and mortality. In 2012, Colombia introduced the vaccine in the compulsory vaccination scheme.

Methods

Ambispective case series study conducted in pediatric patients with meningitis admitted to 10 hospitals of Bogotá (2008-2019), and 4 hospitals of Cali, 2 of Medellín, and 1 of Cartagena (2017-2019). Objective:To perform a clinical, epidemiological and microbiological characterization of patients with meningitis caused by Streptococcus pneumoniae in Colombia from 2008 to 2019, in the hospitals included in Neumocolombia network.

Results

58 cases were related to the pathology. The most frequent symptoms in the cohort were fever, hyporexia and somnolence. Epileptic seizures were particularly common between 4 and 12 months of age. Increased resistance to penicillin and third generation cephalosporins was found in the period 2015-2019. The mortality rate was 20.68%, and the most important sequel was cognitive dysfunction, with a frequency of 73.77%, followed by sensorineural hearing loss, motor disorders and epilepsy. Mortality was associated with low blood cell counts and high C-reactive protein, while age was associated with increased complications and sequelae.

Conclusions

Recent immunization schemes have changed the clinical, microbiological and epidemiological characteristics of pneumococcal meningitis in Colombia.

Background

Invasive pneumococcal disease is a common cause of morbidity and mortality among children, with a case fatality rate of about 8% in children under 5 years. The frequency of primary bacteremia is 20% of the IPD in children under 2 years.

Methods

Observational, descriptive, longitudinal study. Data were obtained from 40 medical records of patients under 18 years diagnosed with bacteremia by pneumococcus and treated in Neumocolombia network hospitals in 2017-2019. A univariate analysis was performed using frequency and bivariate tables with non-parametric Kruskal-Wallis.

Results

60% of the patients were male. Median age was 24 months (IQR 10 - 48). 52% of the patients were under the age of 2; lethality was 10% and immunization with PCV was 10 50%. The most frequent serotype was 19A, followed by 23B, and 25A(20%, 7.5% and 5.0%, respectively). Resistance to erythromycin was 37.5%, to clindamycin 32.5%, penicillin 22.5% and ceftriaxone 15%. 30% of the children were admitted to the ICU. The average hospital stay was 11 days, and 2.5 days in the ICU.

Conclusions

Primary bacteremia by S. pneumoniae in Colombia has a 10% case fatality rate in children under 2 years, the most frequent serotype being 19A. Penicillin resistance was found in 22.5%.

Background

Antibiotic use for acute respiratory illnesses (ARI) is very common in children, but its impact on antibiotic-resistance gene detection among nasopharyngeal (NP) bacteria is incompletely characterized.

Methods

NP samples from children <5 years of age prescribed antibiotics for ARI in ambulatory settings in Nashville, Tennessee were collected at baseline (before antibiotics) and 7 days after the encounter (follow-up). Samples were cultured for Streptococcus pneumoniae and tested for several common pneumococcal antibiotic-resistance genes by real-time PCR.

Results

To date, 7/8 (88%) children who provided paired samples received amoxicillin; 2/8 (25%) received clindamycin. Pneumococcus was detected in 5/8 (63%) baseline and 1/8 (13%) follow-up samples. Pbp2b, mef and ermB genes were detected in 4/8 (50%), 8/8 (100%) and 7/8 (88%) children at baseline, respectively. Pbp2b became undetectable at follow-up in all 4 children with baseline detection. Detection of mef and ermB remained stable or increased in 5/8 (63%) and 5/7 (71%) subjects, respectively (Figure).

Conclusions

In this ongoing study, targeted pneumococcal antibiotic-resistance genes were commonly detected in children before antibiotic treatment and were more prevalent than pneumococcal detection, suggesting that other species may harbor these resistance mechanisms. Antibiotic use may facilitate expansion of certain resistance genes, while minimizing others.

Background

Streptococcus pneumonia (SP) causes morbidity and mortality among children worldwide. India introduced 13-valent pneumococcal conjugate vaccine (PCV-13) in 2017. Current study was conducted to isolate SP from nasopharyngeal (NP) swabs of healthy children and assess changes in serotypes among PCV vaccinated and unvaccinated children.

Methods

Cross-sectional study was conducted (July-August 2019) in Lucknow District, North India. Children (2-59 months) who had no clear illness/hospitalization (last one-month) were recruited from vaccination-clinics of hospitals. After NP specimen collection, bacterial culture was done using 5% sheep agar-blood plate containing gentamicin. Pneumococcal isolates were identified by optochin-sensitivity and bile-solubility. Serotyping was done using Quellung Method

Results

Of 300 children, 56.7%(170/300) were males and 52.0%(156/300) were 2-11 months. Overall SP colonization rate was 37.6% (113/300). Vaccine serotypes isolated were 18C,19A,19F,23F,3,4,6A,6B,9V. Among 60% (181/300) PCV vaccinated, SP positivity was 37.5% (68/181) and vaccine serotype were 39.7% (27/68). Among 40% (119/300) non-PCV vaccinated-children, 37.8%(47/119)had NP colonization positive and PCV-13 serotypes were 37.7%(17/47). Non-Vaccine serotypes were 10A,15A,15B,15C,21,34,35B,22F and similar in vaccinated and unvaccinated children.

Conclusions

About 4 of 10 healthy children had NP colonization with SP and around 40% serotypes were covered by PCV-13. Our preliminary data suggests that SP colonization rate and serotype isolates were similar in vaccinated and unvaccinated children

Background

Despite availability of conjugate (PCV) and pneumococcal polysaccharide vaccines (PPV23), pneumococcal disease remains a global health problem. Emergence of non-vaccine serotypes continues to be a threat. As part of an ongoing program, literature was reviewed to inform recent changes in serotype distribution.

Methods

Medline, EMBASE and Cochrane databases were searched from February 2017–May 2019. Serotype distribution data for children ≤5 years were extracted and summarized.

Results

Serotype data were available in 51 articles covering varying periods from 2012 onwards, including 39 publications from areas/periods where pediatric PCV was part of immunization programs. Most (30) papers covered nasopharyngeal carriage, 21 covered invasive pneumococcal disease (IPD), one each covered acute otitis media and non-IPD, and three pooled IPD and non-IPD. Overall, PCV13, PPV23-specific and non-vaccine serotypes accounted for 39.7%, 27.8% and 32.4% of serotyped isolates, respectively. Six of the 10 most prevalent serotypes were PCV13-specific. Among PPV23 serotypes, 15B/C, 11A and 10A ranked in the top 10. Global prevalence of serotypes 22F and 33F was 0.7% and 0.8%, respectively. The most prevalent non-vaccine serotypes were 23B, 15A/F, 23A, 21 and 16F.

Conclusions

PCV serotypes remain responsible for a significant burden of pneumococcal disease in children, even in countries using PCV.

Background

Surveillance of invasive pneumococcal disease (IPD) is important to understand the effects of direct and indirect protection from pneumococcal vaccination programs and inform vaccine development and policy.

Methods

As part of the ongoing Pneumococcal Pneumonia Epidemiology, Urine Serotyping, and Mental Outcomes (PNEUMO) study, we enrolled adults hospitalized with IPD in Nashville and Atlanta from September-2018 to August-2019. IPD was defined by isolation of Streptococcus pneumoniae from a normally-sterile site.

Results

We enrolled 25 IPD cases, including 18 (72%) pneumonia, 5 (20%) bacteremia without an identified focus, 1 meningitis, and 1 septic arthritis. Pneumococcal serotype was identified from blood culture in 20 cases, including serotypes: 35B–(3 cases), 3-(2 cases), 15A-(2 cases), 19F-(2 cases), 20-(2 cases), 23A-(2 cases), 22F, 8, 9N, 11A, 23B, 31, 35F. Median age was 62 years; 23 (92%) presented from a community residence; 12 (48%) were immunocompromised; and all had ≥1 major chronic medical condition. In-hospital outcomes: 0 deaths; 10 (40%) ICU admissions; 9 (36%) mechanical ventilation; 3 (12%) vasopressors; 3 (12%) pleural drainage procedure; 1 (4%) new renal-replacement-therapy.

Conclusions

IPD is a highly morbid disease in US adults, with most cases in this study caused by serotypes not in the current 13-valent pneumococcal conjugate vaccine.

Background

The heptavalent pneumococcal conjugate vaccine (PCV7) was introduced in Japan in 2010 and switched to 13-valent vaccine (PCV13) in 2013. The aim of this study is to clarify the epidemiological changes in invasive pneumococcal disease (IPD) after the introduction of PCV13 in Japan.

Methods

The effectiveness of PCV13 in protecting against IPD in children aged <5 years and changes in serotypes were evaluated in a nationwide active population-based surveillance of IPD in 10 prefectures in Japan.

Results

Our data confirmed a 62% decline in IPD incidence in children aged <5 years after the introduction of PCV7. After the introduction of PCV13, the number of IPD caused by PCV13 serotypes, especially serotype 19A was dramatically decreased. On the other hand, IPD caused by non-PCV13 serotype increased. The major serotypes of IPD in children was 12F and 24F in 2018. In terms of antimicrobial susceptibility of S. pneumoniae, the number of penicillin G less susceptible strains, especially with serotypes 15A and 35B, increased after PCV13 introduction.

Conclusions

There was a great reduction of IPD caused by PCV13 serotypes following the introduction of PCV13. The serotype distribution of IPD has changed from vaccine types to non-vaccine types. Continuous surveillance is necessary to follow this observed trend.

Background

Parapneumonic empyema, a severe pneumonia complication, decreased shortly after 13-valent pneumococcal conjugate vaccine (PCV13) introduction among young US children but not among older children. We assessed the long-term impact of PCV13 introduction among US children encompassing the transition to the ICD10 coding system.

Methods

We used the National Inpatient Sample and Census Data to calculate national annual all-cause and pneumococcal parapneumonic empyema hospitalization rates among children <18 years (1997-2017). We examined rates during the late PCV13 era (2016-2017) after transition to ICD10 codes compared to pre-PCV7 (1997-1999), PCV7 (2001-2009) and early-PCV13 era (2011-2015) rates. We also examined changes in thoracentesis-related procedures.

Results

All-cause and pneumococcal parapneumonic empyema, as well as thoracentesis-related procedure rates reached historical lows in the late PCV13 era (Table). After initial declines following PCV13 introduction, rates have remained relatively stable (Figure). Modest, mostly downward, fluctuations were noted post-ICD10 transition.

Conclusions

Parapneumonic empyema rates in US children increased following PCV7 introduction but decreased and reached historic lows following PCV13 introduction. The change in coding from ICD9 to ICD10 did not appear to influence trends, though further assessment is warranted. Our findings support the ongoing surveillance of all-cause and pneumococcal empyema in the ICD10 coding era.

Background

Pneumococcal conjugate vaccines (PCVs) reduce antimicrobial resistance (AMR). In Africa, where disease surveillance is limited, nasopharyngeal carriage studies may reveal PCV impact on AMR . We investigated AMR in pneumococcal carriage in Nigeria.

Methods

Nigeria introduced PCV10 between 2014-2016. Random carriage surveys targeting 1000 participants were conducted pre-(2016) and post-PCV10 (2017-2018) in two locations (rural and urban). PCV10 coverage in 2017 and 2018 was 47% and 55%, respectively. Isolates randomly selected from each survey were tested for antimicrobial resistance using broth micro-dilution.

Results

In 571 pneumococcal isolates, prevalence of resistance was -Tetracycline (69%), Cotrimoxazole (68%), Penicillin (43%) and Chloramphenicol (14%). Serotypes 19F, 6A, 11A, 23F, 3, 16F, 19A, 34 and 6B had a high prevalence of resistance. Prevalence of resistance to any antibiotic differed little by pre- vs post-PCV10 era both overall (86% and 85%) and in rural (73% and 71%) and urban (99% and 98%) samples. No difference was seen in prevalence of resistance among vaccine and non-vaccine serotypes by PCV10 era.

Conclusions

Among healthy Nigerians, prevalence of resistance to commonly used antibiotics is high in carried pneumococci. Although the data do not show any impact of PCV10 on resistance prevalence, the lack of effect may be explained by incomplete coverage levels.

Background

The pneumococcal conjugate vaccines (PCVs) were introduced in southwestern Sweden in 2009. Here we assessed associations between pneumococcal serotype distribution, age, predisposing factors, clinical manifestations and case-fatality-rate in patients with invasive pneumococcal disease (IPD).

Methods

Data from 1,278 patients with 1,304 episodes of IPD between January 2009 and December 2015 in southwestern Sweden, were collected from medical records. Pneumococcal isolates were serotyped by gel diffusion and/or Quellung reactions at the Public Health Agency, Sweden.

Results

Except for serotype 3, the prevalence of PCV13 serotypes decreased from 76 % in 2009 to 25 % in 2015, while non-PCV13 serotypes increased, mainly among the elderly and in patients with predisposing factors. Non-PCV13 serotypes were associated with bacteremia with unknown focus, and PCV13 serotypes with invasive pneumonia. Serotype 3 and 4 were associated with intensive care unit admission, whilst serotype 1 and 7F caused IPD among healthier and younger patients. The case-fatality rate was lower for 7F caused IPD (4%) than for all other serotypes (13%).

Conclusions

Non-PCV13 serotypes now dominate among IPD cases in southwestern Sweden, and more often caused disease in patients with predisposing factors as compared to PCV13 types. Serotype 3 is still prevalent and often cause severe IPD.

Background

1. Pneumococci cause many deaths world-wide. In the area around Gothenburg in Sweden invasive pneumococcal disease (IPD) has been studied between 1964 and 2009, before any pneumococcal vaccines were used.

Methods

Information about isolations of pneumococci in blood, CSF, synovial, pleural, pericardial and peritoneal fluid was obtained from all bacteriological laboratories in the area.Data were obtained from individual presentation records

Results

1. Totally 4347 patients with IPD were identified. 69 had IPD more than once. The incidence rose continuously from 4.2 to 13.1 cases /100,000 inhabitants/year. The incidence was highest in individuals ≥65 years (45/100,000/year) followed by infants <2 years (23/100,000/year. The most common clinical presentation was sepsis with unknown focus, followed by pneumonia. Meningitis incidence remained unchanged; 1.1 – 1.2 cases/100 000/year. More than 70 % of adult patients had risk factors (high age, alcoholism, malignant or immunological diseases.

Conclusions

1. IPD is a common problem in Sweden mainly affecting the elderly, infants and patients with obvious risk factors.

Background

Streptococcus pneumoniae is a bacterial pathogen responsible for severe infections in children, especially meningitis. The emergence of multidrug-resistant S.pneumoniae, likely due to indiscriminate antibiotic use, is a serious public health problem in Vietnam. The aim of this study was to survey antimicrobial susceptibility of invasive S. pneumoniae isolates.

Methods

Twenty-five isolates from children <5 years old with meningitis in Southern Vietnam from 2012-2018 were serotyped by realtime PCR and Quellung reaction. Antimicrobial susceptibility was determined by Kirby Bauer (erythromycin, clindamycin, tetracycline, trimethoprim-sulfamethoxazole, chloramphenicol, levofloxacin, rifampin, vancomycin) and MIC methods (penicillin and ceftriaxone) with the data interpreted by CLSI, 2018.

Results

All pneumococcal isolates were non-susceptible to penicillin, erythromycin, clindamycin, and tetracycline, with 92%, 48%, and 20% non-susceptible to trimethoprim-sulfamethoxazole, ceftriaxone, and chloramphenicol, respectively. All isolates were susceptible to levofloxacin, rifampin, and vancomycin. All isolates were non-susceptible to multiple antibiotic classes (at least three classes of antibiotic) with serotype 6A and 6B isolates non-susceptible to most antibiotics tested. Furthermore, higher resistance rates were observed in this study compared to Southern Vietnam in previous periods.

Conclusions

Antibiotic resistance of invasive S. pneumoniae isolates from pediatric patients with meningitis in Southern Vietnam is alarmingly high. Strategies to combat pneumococcal antibiotic resistance are urgently needed.

Background

In Sweden, pneumococcal serotype distribution in adults with community-acquired pneumonia (CAP) and potential coverage of licensed and developmental pneumococcal conjugate vaccines (PCVs) are unknown.

Methods

2016-2018, consecutive patients aged ≥18 years hospitalized with chest x-ray positive (CXR+) CAP were enrolled at Skåne University Hospital. Streptococcus pneumoniae (Spn) blood culture isolates were serotyped by multiprime PCR and Quellung reaction. Urine was tested by the pan-pneumococcal urinary antigen test (BinaxNOW®) and Pfizer’s proprietary serotype-specific urine antigen detection assays (UAD1/UAD2). UAD1 detects serotypes in PCV13, UAD2 detects additional serotypes in PCV15 and PCV20 plus serotypes 2,9N,17F and 20.

Results

Of 567 enrollees, 518 had CXR+CAP and urine sample collected and were included in analysis. Spn serotypes were identified by UAD or blood culture isolates.

Table CXR+CAP by age group and vaccine serotype categories.

*PCV13:1,3,4,5,6A/6C,6B,7F,9V,14,18C,19A,19F,23F

PCV15:PCV13+22F,33F

PCV20:PCV15+8,10A,11A,12F,15B/C

Conclusions

In the context of robust pediatric PCV immunization, PCV13 serotypes were relatively common in adult CXR+CAP, emphasizing the limits of relying on indirect protection. PCV20 will further increase the ability of direct vaccination to reduce adult pneumonia morbidity.

Background

The serotypes causing invasive pneumococcal disease (IPD) have changed significantly since the introduction of the 7-valent (PCV7) and 13-valent (PCV13) pneumococcal conjugate vaccines (PCV) in England. Since case fatality rate (CFR) varies across different pneumococcal serotypes, we analysed trends in deaths and CFR before and after implementation of the two PCV programmes in England

Methods

Public Health England conducts enhanced IPD surveillance in England. Cases and deaths occurring within 7 days of IPD diagnosis were used to calculate CFR during 2002/03-2018/19.

Results

The number of IPD deaths increased from 744 in 2005/16 just before PCV7 was implemented and peaked at 756 in 2009/10 just before PCV13 replaced PCV7 and then declined to 450 cases in 2013/14, when IPD cases were also at their lowest. Since then, IPD cases and deaths increased and peaked in 2018/19 before declining in 2018/19. CFR trends followed IPD deaths until 2008/09 peaking at 14.4% and then gradually declined to 9.9% in 2018/19. This was because the replacing serotypes after PCV13 implementation, especially serotypes 8 and 12F, were associated with lower age-adjusted CFR compared to PCV13 serotypes.

Conclusions

CFR declined only after PCV13 replaced PCV7 in 2010. The current replacing serotypes are associated with lower CFR than PCV13 serotypes.

Background

Parapneumonic empyema, a severe pneumonia complication, increased among US adults (especially older adults) after the introduction of 7-valent pneumococcal conjugate vaccine (PCV7), though the trend since PCV13 introduction remains unclear. We examined parapneumonic and pneumococcal empyema hospitalization rates among US adults during the PCVs era.

Methods

National Inpatient Sample and Census Data were used to calculate national annual all-cause and pneumococcal parapneumonic empyema hospitalization rates among adults. Rates were compared to national invasive pneumococcal disease (IPD) estimates from the CDC Active Bacterial Core surveillance system (1997-2017). We examined age-specific rates by vaccine era [pre-PCV7 (1997-1999); PCV7 (2001-2009); early-PCV13 era (2011-2015); and late-PCV13 (2016-2017) after transition from ICD9 to ICD10 codes].

Results

All-cause parapneumonic empyema hospitalization rates increased in every adult age group during the study period (Table). Pneumococcal parapneumonic empyema hospitalization rates followed similar trends as overall IPD and declined in every age group after PCV13 introduction (Figure). Modest increases were observed after PCV13 introduction for streptococcal parapneumonic empyema and parapneumonic empyema without an identified causative organism.

Conclusions

While the rate of all-cause parapneumonic empyema hospitalizations among US adults has increased in the last 2 decades, modest changes have been observed in pneumococcal parapneumonic empyema with declines following PCV13 introduction.

Background

Invasive Pneumococcal Disease(IPD) causes high mortality in children under 5 years. Colombia started administering PCV10 in 2012. Neumocolombia network monitors IPD in pediatric patients throughout the country.

Methods

Case series study in 69 deceased pediatric patients with IPD admitted to 10 hospitals of Bogotá in 2008-2019, and 4 hospitals of Cali, 2 of Medellín and 1 of Cartagena in 2017-2019(preliminary data).

Results

The average age of sample was 31 months (0-180 months); 57(82%) were younger than 48 months. The average hospital stay was 7.8 days; 59(85.5%) were admitted to the ICU. 39 cases (56%) presented pneumonia, 14(20%) bacteremia, 13(18.8%) meningitis and 3(4.3%) pneumonia plus meningitis. Case fatality rate was 9%(39/429) for pneumonia, 20%(13/65) for meningitis, 10.9%(14/128) for bacteremia, and 37.5%(3/8) for meningitis plus pneumonia. 41 isolates(59%) were serotyped, and the ones with the highest case fatality rate were serotype 3 with 11.6%(5/43), serotype 14 with 10.7%(7/65), and serotype 19A with 8.9%(10/112). 14 cases(20%) had decreased susceptibility to penicillin.

Conclusions

Mortality from IPD is higher in children under two years. The highest lethality was found in patients with meningitis plus pneumonia, and the most lethal serotype was 3.Permanent monitoring of mortality by IPD after the implementation of mass vaccination with PCV10 is necessary.

Background

23-valent polysaccharide (P23, Pneumovax, Merck) and 7- and 13-valent conjugated vaccines (PCV7, PCV13, Prevnar, Pfizer) are in clinical use, with 15-valent (PCV15, V114, Merck), and 20-valent (PCV20, PF-06482077, Pfizer) conjugated vaccines under development.

Methods

This study compares vaccine coverage of serotypes of pneumococcal isolates from all sources from the year prior to PCV7 introduction (1999), the period following use of PCV7 (2000-2009), the year of PCV13 introduction (2010), and the period since introduction of PCV13 (2011-2019).

Results

2,336 S. pneumoniae were isolated, 196 in 1999, 1,369 in 2000-2009, 68 in 2010 and 708 in 2011-2019 (Table). PCV7 serotypes decreased from 68.8% in 1999 to <12.4% after 2003. Twenty-eight isolates with serotypes included in PCV7 were recovered 2015-2019, with 25 (89%) serotype 19F. The 6 serotypes added to PCV13 accounted for <20% of isolates 1999-2003, increasing to around 45% 2004-2009, and decreasing to <20% thereafter, with types 3 (50/76) and 19A (23/76) predominating. Serotypes included in PVC15, PCV20 and P23 improved coverage of types in PCV13 by 4.6%, 13.9% and 18.9%, respectively, during 2017-2019.

Conclusions

The proportion of PCV7 and PCV13 serotypes decreased considerably after their introduction. P23 and the two conjugated vaccines in development increase coverage of serotypes not in PCV13.

Background

Although invasive pneumococcal disease(IPD) in adults is associated with significant morbidity and mortality, data are yet scarce in low- and middle-income countries. We aimed to characterize clinical outcomes of adults ≥18 years with IPD in Colombia

Methods

A descriptive, observational, and retrospective chart review study was conducted in 5 tertiary hospitals in Bogotá(Colombia) in adults ≥18y with IPD between 2011-2017. Data on demographics, clinical characteristics and serotypes were collected. The main variables analyzed were clinical presentation, length of stay(LOS), UCI admission, case-fatality rate(CFR) and serotype(ST) distribution.

Results

169 cases were included, 48.5%were female and the median age was 58y(IQR:45–70). The main clinical presentation was bacteremic pneumonia (63.3%), followed by bacteremia (19.5%), meningitis (13.6%) and others (3.1%). The median LOS was 12days(IQR:4-20), 58.6% were admitted to UCI(median 5days(IQR:2–13.3)). 53.3% required mechanical ventilation and 50.9% inotropic support. Among 114 cases which had serotyping data, most frequent ST were: 3(11.4%), 14(9.6%), 19A(8.8%), 6C(6.1%), and 6A(5.3%). Table 1 shows CFR per age group, clinical presentation, and main ST.

Conclusions

IPD was associated with high mortality and UCI admission. Although most cases of deaths were due to pneumonia, higher CFR were seen in adults ≥60y, in bacteremia/meningitis presentations, and ST 3 and 6C.

Background

Invasive pneumococcal pneumonia (IPP) is a growing health problem, yet data is scarce on the burden of disease in adults. This study describes the clinical and microbiological characteristics of IPP among adults in Colombia.

Methods

A descriptive, observational and retrospective chart review study was conducted in 5 tertiary hospitals in Bogotá, Colombia(2011-2017). Adults ≥18y with IPP defined as pneumonia with pneumococcus isolation in blood/pleural fluid were included. Data on demographics, clinical characteristics, serotypes, and antibiotic susceptibility were collected.

Results

108 IPP cases were identified. The median age was 59y and 55.6% were male. The most frequent comorbidities were: cardiovascular disease(32.4%), chronic pulmonary disease (29%), and malignant neoplasm(23.1%). The most frequent x-ray findings were: lobar consolidation(21.3%), multilobar consolidation(15.5%) and lobar consolidation with pleural effusion(13%). 53.7% of patients required ICU, 52.8% mechanical ventilation and 52.8% inotropics. Case-fatality rate was 37%. The most frequent serotypes were: 3(9.3%), 14(8.3%), 19A(5.6%) and 6C(3.7%). The susceptibility to penicillin was 87.5% and to ceftriaxone 91.7%.

Conclusions

IPP was associated with a substantial ICU admission and lethality. Over one-third of IPP patients had comorbidities. Serotypes not included in the childhood pneumococcal immunization program predominated. It is essential to continue monitoring serotypes to guide vaccine recommendations in Colombia.

Background

Pneumococcal disease remains a global health problem despite availability of vaccines (pneumococcal polysaccharide (PPV23) and pneumococcal conjugate vaccines (PCV)). Non-vaccine serotypes have emerged. As part of ongoing surveillance to monitor vaccine impact and identify newly emerging serotypes, literature was reviewed.

Methods

Medline, EMBASE, and Cochrane databases were searched from February 2017 to May 2019. Serotype distribution data for adults ≥18 years were extracted and summarized.

Results

Serotype data were available in 22 articles covering 2012 onwards with the majority from areas where PCV was part of a pediatric immunization program. Articles covered invasive pneumococcal disease (IPD) (n=14), non-IPD (n=4), carriage (n=3), and IPD and non-IPD combined (n=1). Serotypes included in PCV13, PPV23, or in no vaccine accounted for 32.8%, 42.0% and 25.3% of serotyped isolates, respectively. The most common PCV13 and PPV23 serotypes were 3, 19A & 7F and 3, 8 & 22F, respectively. The most common non-vaccine serotypes were 15A, 6C and 23A. A similar distribution was seen among adults ≥65 years. PCV13 serotypes were more prevalent in non-IPD and carriage.

Conclusions

After pediatric PCV adoption in various countries, several vaccine and non-vaccine serotypes remain responsible for a significant burden of disease among adults, informing the needs for future adult vaccines.

Background

Pneumococcal meningitis is associated with high mortality rates and approximately half of survivors present neurological sequelae. About one third of the cases appear as a complication of a primary otogenic infection.

Methods

We present two cases of pneumococcal meningitis in previously healthy, unvaccinated children under 5 years of age, admitted to a tertiary hospital from Bucharest, Romania, secondary to otic focus.

Results

For both cases, the cultures from cerebrospinal fluid were positive for penicillin-resistant S. pneumoniae, serotype 14 and 23F, respectively. In the first case, a 3-year old male patient, the cerebral CT and MRI revealed bilateral otomastoditis and after 14 days of treatment, cranial nerve III palsy occurred, most probably due to vasculitis. In the second case, a 4-year-old male patient, the pachymeninx was observed on cerebral imagistic (MRI) and in evolution the child developed hearing loss.

Conclusions

We presented the cases of two children, with pneumococcal meningitis with an otic starting point, who despite of the imperative antibiotic and pathogenic treatment developed important complications. Pneumococcal vaccination remains the only method of preventing pneumococcal invasive diseases.

Background

Pneumonia in children remains a public health problem and a major contributor to morbidity and mortality in young children worldwide especially in low resource countries. In Ghana, the pneumococcal conjugate vaccine (PCV) was added to the expanded program on immunisation in May 2012. Despite this, pneumonia remains a leading cause of hospital admissions in young children.

Methods

We prospectively recorded cases of pneumonia in an electronic database of children admitted to the Paediatric Emergency Unit of the Komfo Anokye Teaching Hospital from September 2018 to April 2019. Data was then analysed with STATA version 16.

Results

During the 8-month period, 174 children were admitted with pneumonia to the unit, 96% (n=166) were younger than 5years of age and 48% (n=84) were below age 12 months. In all 93.6% (n=163) of cases had received at least two doses of PCV. However, ninety four percent of cases (n=164) presented with severe pneumonia,19% (n=33) were hypoxic at presentation, and 16% (n=29) died from complications of pneumonia

Conclusions

Despite high PCV coverage, pneumonia remains an important cause of admission with a significant number presenting with severe pneumonia and death.

Background

Despite high vaccine coverage rates in children and efficacy of pneumococcal conjugate vaccines, invasive pneumococcal disease (IPD) episodes due to serotypes included in the vaccine following completion of the recommended course of immunisation [i.e. vaccine failure (VF)] have been reported.

Methods

Cases of IPD in children <18 years of age were detected through an enhanced surveillance system. Parents/physicians/providers are interviewed for confirmation of demographic and clinical data. All Streptococcus pneumoniae from sterile body sites are submitted to Department of Public Health and serotyped by Quellung reaction.

Results

Out of 307 IPD cases identified during 2010/2017 following implementation of PCV13, 101 (32.9%) were due to PCV13 serotypes and 27 (8.8%) were among children who completed age-recommended immunization schedule (Table). Median age was 26 months, 21 (67.7%) were male and 6 (22.2%) of cases had >1 comorbidity. Serotype 19A (n=13, 48.2%) and 3 (n=11, 40.7%) were responsible for majority of VF cases. Mortality rate among VF cases was 11.1%.

Conclusions

PCVs are highly effective, but sustaining high vaccine coverage, ongoing surveillance and understanding the mechanisms involved in VF cases is essential

Background

7-valent-pneumococcal-conjugated-vaccine(PCV7) was implemented in Massachusetts in 2000 and was replaced by PCV13 in 2010. We assessed the impact of PCVs on the epidemiology of pneumococcal central nervous system disease(PCNS).

Methods

A population-based, enhanced surveillance for IPD among Massachusetts children is ongoing since 2001. Pneumococcal isolates from normally sterile body sites are sent to the Department of Public Health and serotyped using Quellung-reaction. Parents/guardians/providers are interviewed to obtain demographic and clinical information.

Results

Eighty-three PCNS cases were identified between 04/2002-03/2017. Incidence of PCNS declined 65% in all ages in 2016/2017 compared to prePCV13 baseline (0.27/100,000 vs 0.77/100,000, rate ratio 0.38, 95%CI 0.02-0.47)(Figure). Median age was 17-months in prePCV13-era and 41-months in postPCV13-era. Twenty-seven (32.5%) children had >1 comorbidity. Mortality rate was 8.4%. Serotypes 19A(17.0%), 22F(9.4%), 6C,7F (7.6% each), 3,33F(5.7% each) were the most frequent serotypes in the prePCV13-era; 15B,23B(16% each), 3, 33F, 10A, 20(10.5% each) were the most frequent serotypes in the postPCV13-era. Nonvaccine serotypes (NVST) were isolated in 30(56.6%) and 16(84.2%) PCNS cases in prePCV13 and postPCV13 eras, respectively. Five(14.4%) and one(5.3%) isolates were ceftriaxone non-susceptible in prePCV13 and postPCV13-era, respectively.

Conclusions

Incidence of PCNS has declined 65% since 2002. It now occurs in older children and is most often caused by NVST.

Background

Azithromycin is a useful therapeutic, but its long half-life encourages development of azolide/macrolide resistance. We investigated increasing macrolide-resistance among Streptococcus pneumoniae, exploring the association of macrolide-resistance with serotype, clone and azithromycin use.

Methods

Between January-2002 to March-2015, 464 invasive pneumococcal isolates were collected and whole-genome sequenced. Azolide/macrolide non-susceptibility was determined by erythromycin disk-diffusion and E-test.

Results

We identified macrolide resistance in 70 (15%) pneumococci; 64% of which harbored ermB, 33% mefA and 1.4% carried both the genetic determinants. Few (n=6 of 265 tested) were identified through 2009; subsequently resistance increased to 46% in 2014, and 60% in 2015. Macrolide-resistant pneumococci exhibited 24 serotypes; 19F (14%), 6B (13%) and 23F (13%) were predominant. PCV10, PCV13, and PCV20 would address 51% (36/70), 56% (39/70), and 63% (44/70), respectively. Macrolide-resistant pneumococci belonged to 26 GPSCs and 42 STs. Dominant lineages were GPSC10 (ST1553, 12894, 14490, 14488), GPSC43 (ST4745, 3214), GPSC101 (ST2854, 1078) and GPSC482 (ST5612). Increased azithromycin consumption showed direct association with increasing macrolide-resistance during this period (r=0.8572, p=0.0031, Spearman correlation coefficient).

Conclusions

Serotype and genotype diversity among macrolide-resistant pneumococci and low proportion addressed by PCVs suggests that a vaccine covering all strains or restricted consumption of azithromycin is needed to reduce transmission of macrolide-resistant strains.

Background

Systemic inflammation from pneumonia may lead to acute brain dysfunction and long-term cognitive impairment, especially in older patients with severe pneumonia.

Methods

As part of the ongoing Pneumococcal Pneumonia Epidemiology, Urine Serotyping, and Mental Outcomes (PNEUMO) study, we prospectively enrolled adults hospitalized with community-acquired pneumonia. We tested for Streptococcus pneumoniae with cultures and BinaxNOW urinary antigen tests. We assessed global cognition in patients ≥50 years old with the Montreal Cognitive Assessment-Blind Adaptation (MoCA-Blind). MoCA-Blind scores range from 0 to 22 with higher scores indicating better cognition. Adults with a MoCA-Blind score <18 are considered to have cognitive impairment. We administered the MoCA-Blind instrument at enrollment when the patient was acutely ill and 6-months later by phone.

Results

At the time of this interim analysis, 150 patients had cognitive assessments completed at enrollment and 6-months, including 12 (8.0%) with pneumococcal pneumonia. Median (IQR) age was 64 (58-71) years. Cognitive impairment was common at both enrollment and 6-months later (Figure). At 6-month follow-up, 58% of pneumococcal and 52% of non-pneumococcal pneumonia patients had a MoCA-Blind score <18.

Conclusions

Hospitalization for pneumonia, including pneumococcal pneumonia, is associated with high risk of acute and persistent cognitive impairment among US adults ≥50 years old.

Background

Prevalence of community acquiered pneumonia (CAP) in children at West Sumatra is quite high. Severe pneumonia will be referred to dr. M.Djamil hospital as three level hospital.

Methods

This research is an observational descriptive study by using medical record of children with primary diagnosis of CAP in period of January 2016 until 31 December 2018. We collected demographic data and clinical data.

Results

Patients were diagnosed as CAP, 56.3% found in boys, especially the age group 2- <12 months 54.6% with good nutritional status 60.1% and 46.4% have incomplete immunization status. The chief complaint are shortness of breath 80.3% and clinical symptoms such as shortness of breath found 88.5%. The laboratory test showed leukocytes 61.2% within normal limits and infiltrate found in 84.6% chest radiograph. Accompanying diseases that often are congenital heart disease 24% and complications that occur in acid-base balance disorders 24.6%. The hospital length of stay for children is > 5 days at 81.4%.

Conclusions

The clinical spectrum of community acquired pneumonia in hospitalized children at RSUP DR. M. Djamil have high variation and it is influenced by several factors.