The changing epidemiology of community‐acquired pneumonia: nationwide register‐based study in Sweden

Abstract

Background There is limited evidence on the impact of pneumococcal conjugate vaccine childhood immunization programmes (PCV‐CIP) on community‐acquired pneumonia (CAP) in individuals with underlying diseases. Methods A nationwide cohort study using Swedish health registers to assess the incidence of hospitalization with all‐cause (AC‐CAP) and pneumococcal or lobar (PL‐CAP) CAP between 2005 and 2015, in relation to PCV‐CIP introduction in 2007–09. Results In total, 303 691 episodes of AC‐CAP occurred, of which 14 225 were PL‐CAP. Comparing before (2005–06) with after (2014–15) PCV‐CIP, relative incidence reductions were 36% (95% Confidence Interval 32–40), 20% (14–25) and 16% (11–22) of AC‐CAP for age groups < 2, 2–4 and 5–17 years, respectively, with similar reductions in young children with and without comorbidities. The reductions were more pronounced for PL‐CAP. In the age groups 40–64, 65–74, 75–84 and ≥85 years there were relative increases of 11% (8–14), 18% (15–22), 15% (12–17) and 30% (27–34) of AC‐CAP, respectively, but these increases were attenuated after adjustment for admittance practices using four control conditions. In adults with comorbidities, there was an increase in incidence of AC‐CAP, and PL‐CAP, in contrast to adults without reported underlying diseases where the incidence was stable or diminished for some age groups. Over the study period, there was an increased proportion of pneumonia patients with underlying diseases in all ages. Conclusion This emphasizes that direct preventive interventions should be targeted towards individuals with underlying diseases. Future studies should investigate reasons for the observed increased risk in adults with comorbidities, for example due to pneumococcal nonvaccine serotypes, or other pathogens, preferentially affecting subjects with underlying diseases.

Pathogens Isolated in Respiratory Tract Samples of Recently Hospitalized Patients: Implications for Primary Care Physicians

“…In such patients an initial or follow up treatment using penicillins with or without β-lactamase inhibitors, macrolides, or 2nd generation cephalosporins may be inadequate. Fluoroquinolones, and more speci cally the so called "respiratory" uoroquinolones, provide excellent coverage according to our data and those of previous studies [19][20][21]. The use of uoroquinolones, however, has several important drawbacks for patients with signi cant comorbidities.…”

Pathogens isolated in respiratory tract samples of recently hospitalized patients: Implications for primary care physicians

“…In such patients an initial or follow up treatment using penicillins with or without β-lactamase inhibitors, macrolides, or 2 nd generation cephalosporins may be inadequate. Fluoroquinolones, and more speci cally the so called "respiratory" uoroquinolones, provide excellent coverage according to our data and those of previous studies [19][20][21]. The use of uoroquinolones, however, has several important drawbacks for patients with signi cant comorbidities.…”

Impact of the 13-valent pneumococcal conjugate vaccine on the incidences of community-acquired pneumonia and pneumonia-related hospitalizations in children ≤5 years after its implementation into the national immunization program of Turkey

“…Naucler et al investigated the changing epidemiology of CAP in Sweden by using a nationwide registry system. 19 They showed that the incidences of CAP decreased significantly by 36%, 20%, and 16%, respectively for ages <2, 2-4, and 5-17 years, when the pre-PCV period (years 2005-2006) was compared with the post-PCV period (years 2014-2015). 19 Similar results have been observed in studies conducted in other European countries, including Italy, the Netherlands, Israel, and France.…”

“…19 They showed that the incidences of CAP decreased significantly by 36%, 20%, and 16%, respectively for ages <2, 2-4, and 5-17 years, when the pre-PCV period (years 2005-2006) was compared with the post-PCV period (years 2014-2015). 19 Similar results have been observed in studies conducted in other European countries, including Italy, the Netherlands, Israel, and France. [20][21][22][23][24] Our study is the second to evaluate long term (over at least 7 years) impact of PCV13 on CAP and CAP-related hospitalization.…”