Community-Acquired Pneumonia Requiring Hospitalization among U.S. Children
Published Date:Feb 26 2015
Source:N Engl J Med. 372(9):835-845.
Corporate Authors:for the Centers for Disease Control and Prevention (CDC) Etiology of Pneumonia in the Community (EPIC) Study Team
Respiratory Syncytial Viruses
Pubmed Central ID:PMC4697461
Funding:CC999999/Intramural CDC HHS/United States
K23 AI104779/AI/NIAID NIH HHS/United States
U18 IP000299/IP/NCIRD CDC HHS/United States
U18 IP000301/IP/NCIRD CDC HHS/United States
U18 IP000302/IP/NCIRD CDC HHS/United States
U18 IP000303/IP/NCIRD CDC HHS/United States
U18 IP000488/IP/NCIRD CDC HHS/United States
U18 IP000489/IP/NCIRD CDC HHS/United States
U18 IP000490/IP/NCIRD CDC HHS/United States
U18 IP000491/IP/NCIRD CDC HHS/United States
U.S. incidence estimates of pediatric community-acquired pneumonia hospitalizations based on prospective data collection are limited. Updated estimates with radiographic confirmation and current laboratory diagnostics are needed.
We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among children <18 years in three hospitals in Memphis, Nashville, and Salt Lake City. We excluded children with recent hospitalization and severe immunosuppression. Blood and respiratory specimens were systematically collected for pathogen detection by multiple modalities. Chest radiographs were independently reviewed by study radiologists. We calculated population-based incidence rates of community-acquired pneumonia hospitalizations, overall and by age and pathogen.
From January 2010-June 2012, we enrolled 2638 (69%) of 3803 eligible children; 2358 (89%) had radiographic pneumonia. Median age was 2 years (interquartile range 1-6); 497 (21%) children required intensive care, and three (<1%) died. Among 2222 children with radiographic pneumonia and specimens available for both bacterial and viral testing, a viral and/or bacterial pathogen was detected in 1802 (81%); ≥1 virus in 1472 (66%), bacteria in 175 (8%), and bacterial-viral co-detection in 155 (7%). Annual pneumonia incidence was 15.7/10,000 children [95% confidence interval (CI) 14.9-16.5], with highest rates among children <2 years [62.2/10,000 (CI 57.6-67.1)]. Respiratory syncytial virus (37% vs. 8%), adenovirus (15% vs. 3%), and human metapneumovirus (15% vs. 8%) were more commonly detected in children <5 years compared with older children; Mycoplasma pneumoniae (19% vs. 3%) was more common in children ≥5 years.
Pediatric community-acquired pneumonia hospitalization burden was highest among the very young, with respiratory viruses most commonly detected.
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