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. 2015 Oct 21;10(10):e0140939.
doi: 10.1371/journal.pone.0140939. eCollection 2015.

Incidence of Hospitalized Pneumococcal Pneumonia among Adults in Guatemala, 2008-2012

Carmen Lucía Contreras  1 , Jennifer R Verani  2 , María Renee Lopez  1 , Antonio Paredes  3 , Chris Bernart  1 , Fabiola Moscoso  1 , Aleida Roldan  1 , Wences Arvelo  4 , Kim A Lindblade  4 , John P McCracken  1
Affiliations

Incidence of Hospitalized Pneumococcal Pneumonia among Adults in Guatemala, 2008-2012

Carmen Lucía Contreras et al. PLoS One. .

Abstract

Background: Streptococcus pneumoniae is a leading cause of pneumonia worldwide. However, the burden of pneumococcal pneumonia among adults in low- and middle-income countries is not well described.

Methods: Data from 2008-2012 was analyzed from two surveillance sites in Guatemala to describe the incidence of pneumococcal pneumonia in adults. A case of hospitalized pneumococcal pneumonia was defined as a positive pneumococcal urinary antigen test or blood culture in persons aged ≥ 18 years hospitalized with an acute respiratory infection (ARI).

Results: Among 1595 adults admitted with ARI, 1363 (82%) had either urine testing (n = 1286) or blood culture (n = 338) performed. Of these, 188 (14%) had pneumococcal pneumonia, including 173 detected by urine only, 8 by blood culture only, and 7 by both methods. Incidence rates increased with age, with the lowest rate among 18-24 year-olds (2.75/100,000) and the highest among ≥65 year-olds (31.3/100,000). The adjusted incidence of hospitalized pneumococcal pneumonia was 18.6/100,000 overall, with in-hospital mortality of 5%.

Conclusions: An important burden of hospitalized pneumococcal pneumonia in adults was described, particularly for the elderly. However, even adjusted rates likely underestimate the true burden of pneumococcal pneumonia in the community. These data provide a baseline against which to measure the indirect effects of the 2013 introduction of the pneumococcal conjugate vaccine in children in Guatemala.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Ascertainment of pneumococcal pneumonia within hospital surveillance of acute respiratory infection (ARI), Guatemala, 2008–2012.
Flow diagram of patients included in this analysis.
Fig 2
Fig 2. Number of hospitalized ARI tested and pneumococcal pneumonia cases by month, Guatemala, 2008–2012*.
Pneumococcal pneumonia cases detected by urine antigen test or blood culture.
Fig 3
Fig 3. Hospitalized pneumococcal pneumonia incidence rates and proportion of acute respiratory infection (ARI) cases by age, Guatemala, 2008–2012.
Incidence rates (bars) ranged from 2.75/100,000 (among 18–24 year-olds) to as high as 31.3 per 100,000 (among adults aged ≥65 years). Proportion of ARI positive for pneumococcus (line) was more stable than the incidence rate across age groups.
See this image and copyright information in PMC

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