title: Community-acquired pneumonia requiring hospitalization among U.S. children.
abstract: 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.).
authors.affiliation: From 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.).
authors.forename: Seema
authors.initials: S
authors.lastname: Jain
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Williams
authors.forename: Sandra R
authors.initials: SR
authors.lastname: Arnold
authors.forename: Krow
authors.initials: K
authors.lastname: Ampofo
authors.forename: Anna M
authors.initials: AM
authors.lastname: Bramley
authors.forename: Carrie
authors.initials: C
authors.lastname: Reed
authors.forename: Chris
authors.initials: C
authors.lastname: Stockmann
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Anderson
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Grijalva
authors.forename: Wesley H
authors.initials: WH
authors.lastname: Self
authors.forename: Yuwei
authors.initials: Y
authors.lastname: Zhu
authors.forename: Anami
authors.initials: A
authors.lastname: Patel
authors.forename: Weston
authors.initials: W
authors.lastname: Hymas
authors.forename: James D
authors.initials: JD
authors.lastname: Chappell
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kaufman
authors.forename: J Herman
authors.initials: JH
authors.lastname: Kan
authors.forename: David
authors.initials: D
authors.lastname: Dansie
authors.forename: Noel
authors.initials: N
authors.lastname: Lenny
authors.forename: David R
authors.initials: DR
authors.lastname: Hillyard
authors.forename: Lia M
authors.initials: LM
authors.lastname: Haynes
authors.forename: Min
authors.initials: M
authors.lastname: Levine
authors.forename: Stephen
authors.initials: S
authors.lastname: Lindstrom
authors.forename: Jonas M
authors.initials: JM
authors.lastname: Winchell
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Katz
authors.forename: Dean
authors.initials: D
authors.lastname: Erdman
authors.forename: Eileen
authors.initials: E
authors.lastname: Schneider
authors.forename: Lauri A
authors.initials: LA
authors.lastname: Hicks
authors.forename: Richard G
authors.initials: RG
authors.lastname: Wunderink
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Edwards
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Pavia
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: McCullers
authors.forename: Lyn
authors.initials: L
authors.lastname: Finelli
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D029121:Metapneumovirus / Q000302:isolation & purification; D009177:Mycoplasma pneumoniae / Q000302:isolation & purification; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology; D011024:Pneumonia, Viral / Q000453:epidemiology; D011159:Population Surveillance; D011859:Radiography; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification; D013714:Tennessee / Q000453:epidemiology; D014589:Utah / Q000453:epidemiology