Because the epidemiology of pneumonia is changing, we performed an updated, population-based analysis of hospitalization and case-fatality rates for pneumonia patients in the United States. From 2002 to 2011, hospitalization rates decreased significantly for pneumonia caused by pneumococcus and Haemophilus influenzae but increased significantly for Pseudomonas spp., Staphylococcus aureus, and influenza virus.

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Background: In the United States, syphilis cases have increased dramatically over the last decade. Recognition and timely diagnosis by medical providers are essential to treating syphilis and preventing further transmission. Methods: From 2016 to 2017, a cross-sectional survey was performed among medical students, residents, fellows, and attending physicians in Rhode Island. Topics included demographics, level of medical training, experience diagnosing and treating syphilis, and familiarity with the reverse testing algorithm. Participants were asked 25 true/false questions to assess basic knowledge of syphilis, which covered five domains: epidemiology, transmission, clinical signs and symptoms, diagnosis, and treatment. Univariate and bivariate analyses were performed to determine knowledge levels across provider characteristics. Significance was defined as p < 0.05. Results: Of the 231 participants, 45% were medical students, 34% were residents or fellows, 11% were medicine attendings (non-infectious diseases), and 10% were infectious diseases attendings. The overall mean score was 9.79 (out of 25; range = 0–23, p ⩽ 0.001). Mean scores differed significantly ( p < 0.001) across groups, including 7.68 for students (range = 0–16), 10.61 for residents/fellows (range = 3–17), 10.41 for non-infectious diseases attendings (range = 4–18), and 16.38 for infectious diseases attendings (range = 6–23). Familiarity with the reverse sequence algorithm was low with only 22% having heard of it. Infectious diseases attendings were significantly more knowledgeable compared to other groups. Overall and across domains, infectious diseases attendings had significantly higher scores except when compared to non-infectious diseases attendings in the epidemiology domain and residents/fellows in the transmission domain. Conclusion: Overall syphilis knowledge among non-infectious diseases medical providers was low. Improved education and clinical training are needed to promote early diagnosis, treatment, and prevention efforts.

IMPORTANCE Severity scores are used to improve triage of hospitalized patients in high-income settings, but the scores may not translate well to low-and middle-income settings such as sub-Saharan Africa. OBJECTIVE To assess the performance of the Universal Vital Assessment (UVA) score, derived in 2017, compared with other illness severity scores for predicting in-hospital mortality among adults with febrile illness in northern Tanzania. DESIGN, SETTING, AND PARTICIPANTSThis prognostic study used clinical data collected for the duration of hospitalization among patients with febrile illness admitted to Kilimanjaro Christian Medical Centre or Mawenzi Regional Referral Hospital in Moshi, Tanzania, from September 2016 through May 2019. All adult and pediatric patients with a history of fever within 72 hours or a tympanic temperature of 38.0 °C or higher at screening were eligible for enrollment. Of 3761 eligible participants, 1132 (30.1%) were enrolled in the parent study; of those, 597 adults 18 years or older were included in this analysis. Data were analyzed from December 2019 to September 2021. EXPOSURES Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS) assessment, and UVA. MAIN OUTCOMES AND MEASURESThe main outcome was in-hospital mortality during the same hospitalization as the participant's enrollment. Crude risk ratios and 95% CIs for in-hospital death were calculated using log-binomial risk regression for proposed score cutoffs for each of the illness severity scores. The area under the receiver operating characteristic curve (AUROC) for estimating the risk of in-hospital death was calculated for each score. RESULTS Among 597 participants, the median age was 43 years (IQR, 31-56 years); 300 participants (50.3%) were female, 198 (33.2%) were HIV-infected, and in-hospital death occurred in 55 (9.2%).By higher risk score strata for each score, compared with lower risk strata, risk ratios for in-hospital death were 3.7 (95% CI, 2.2-6.2) for a MEWS of 5 or higher; 2.7 (95% CI, 0.9-7.8) for a NEWS of 5 or 6; 9.6 (95% CI, 4.2-22.2) for a NEWS of 7 or higher; 4.8 (95% CI, 1.2-20.2) for a qSOFA score of 1; 15.4 (95% CI, 3.8-63.1) for a qSOFA score of 2 or higher; 2.5 (95% CI, 1.2-5.2) for a SIRS score of 2 or higher; 9.1 (95% CI, 2.7-30.3) for a UVA score of 2 to 4; and 30.6 (95% CI, 9.6-97.8) for a UVA score of 5 or higher. The AUROCs, using all ordinal values, were 0.85 (95% CI, 0.80-0.90) for the UVA score, 0.81 (95% CI, 0.75-0.87) for the NEWS, 0.75 (95% CI, 0.69-0.82) for the MEWS, 0.73 (95% CI, 0.67-0.79) for the qSOFA score, and 0.63 (95% CI, 0.56-0.71) for the SIRS score. The AUROC for the UVA score (continued) Key Points Question How does the Universal Vital Assessment (UVA) score perform compared with other common illness severity scores in predicting in-hospital death for febrile hospitalized patients in a lower-income setting? Findings In this prognostic study of 597 adults hospitalize...