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Community-acquired pneumonia requiring hospitalization among U.S. children
Seema Jain1, Derek J Williams, Sandra R Arnold
1From the Centers for Disease Control and Prevention, Atlanta (S.J., A.M.B., C.R., L.M.H., M.L., S.L., J.M.W., J.M.K., D.E., E.S., L.A.H., L.F.); Vanderbilt University School of Medicine (D.J.W., C.G.G., W.H.S., Y.Z., J.D.C., J.H.K., K.M.E.), Monroe Carell Jr. Children's Hospital at Vanderbilt (D.J.W., K.M.E.), and Vanderbilt Vaccine Research Program (D.J.W., K.M.E.), Nashville, and Le Bonheur Children's Hospital (S.R.A., A.P., N.L., J.A.M.), University of Tennessee Health Science Center (S.R.A., A.P., R.A.K., N.L., J.A.M.), and St. Jude Children's Research Hospital (R.A.K., J.A.M.), Memphis - all in Tennessee; University of Utah Health Sciences Center, Salt Lake City (K.A., C.S., W.H., D.D., D.R.H., A.T.P.); and Northwestern University Feinberg School of Medicine, Chicago (E.J.A., R.G.W.).
Insights
Hospitalizations for community-acquired pneumonia are most common in young children, with respiratory viruses being the leading cause. This study provides updated incidence estimates for pediatric pneumonia in the US.
Area of Science:
- Pediatric Infectious Diseases
- Public Health Surveillance
- Respiratory Medicine
Background:
- Limited prospective data exist on community-acquired pneumonia (CAP) hospitalizations in U.S. children.
- Updated incidence estimates using current diagnostic methods are needed.
Purpose of the Study:
- To determine the incidence and causes of radiographically confirmed CAP requiring hospitalization in children in the U.S.
- To identify demographic and pathogen-specific risk factors for pediatric pneumonia.
Main Methods:
- Active population-based surveillance was conducted in three U.S. hospitals from January 2010 to June 2012.
- Children under 18 requiring hospitalization for CAP were enrolled, with exclusions for recent hospitalization or severe immunosuppression.
- Pathogen detection involved systematic collection of blood and respiratory specimens, alongside independent radiograph review.
Main Results:
- The annual incidence of pneumonia was 15.7 per 10,000 children, highest in those under 2 years (62.2 per 10,000).
- A pathogen was detected in 81% of cases; viruses were most common (66%), followed by bacteria (8%).
- Respiratory syncytial virus (RSV) was prevalent in children under 5, while Mycoplasma pneumoniae was more common in older children.
Conclusions:
- Community-acquired pneumonia hospitalization burden is highest in very young children.
- Respiratory viruses are the most frequent etiologies identified in hospitalized pediatric CAP cases.
- Findings underscore the need for targeted prevention and treatment strategies for pediatric pneumonia.
Background:
Incidence estimates of hospitalizations for community-acquired pneumonia among children in the United States that are based on prospective data collection are limited. Updated estimates of pneumonia that has been confirmed radiographically and with the use of current laboratory diagnostic tests are needed.
Methods:
We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among children younger than 18 years of age in three hospitals in Memphis, Nashville, and Salt Lake City. We excluded children with recent hospitalization or severe immunosuppression. Blood and respiratory specimens were systematically collected for pathogen detection with the use of multiple methods. Chest radiographs were reviewed independently by study radiologists.
Results:
From January 2010 through June 2012, we enrolled 2638 of 3803 eligible children (69%), 2358 of whom (89%) had radiographic evidence of pneumonia. The median age of the children was 2 years (interquartile range, 1 to 6); 497 of 2358 children (21%) required intensive care, and 3 (<1%) died. Among 2222 children with radiographic evidence of pneumonia and with specimens available for bacterial and viral testing, a viral or bacterial pathogen was detected in 1802 (81%), one or more viruses in 1472 (66%), bacteria in 175 (8%), and both bacterial and viral pathogens in 155 (7%). The annual incidence of pneumonia was 15.7 cases per 10,000 children (95% confidence interval [CI], 14.9 to 16.5), with the highest rate among children younger than 2 years of age (62.2 cases per 10,000 children; 95% CI, 57.6 to 67.1). Respiratory syncytial virus was more common among children younger than 5 years of age than among older children (37% vs. 8%), as were adenovirus (15% vs. 3%) and human metapneumovirus (15% vs. 8%). Mycoplasma pneumoniae was more common among children 5 years of age or older than among younger children (19% vs. 3%).
Conclusions:
The burden of hospitalization for children with community-acquired pneumonia was highest among the very young, with respiratory viruses the most commonly detected causes of pneumonia. (Funded by the Influenza Division of the National Center for Immunization and Respiratory Diseases.).
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