Incidence of Hospitalized Pneumococcal Pneumonia among Adults in Guatemala, 2008-2012.
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.
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
Carmen Lucía
CL
Contreras
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America.
Jennifer R
JR
Verani
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
María Renee
MR
Lopez
National Center for Epidemiology, Ministry of Public Health and Social Welfare (MSPAS), Guatemala City, Guatemala.
Antonio
A
Paredes
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
Chris
C
Bernart
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
Fabiola
F
Moscoso
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
Aleida
A
Roldan
Division of Global Disease Detection and Emergency Response, Centers for Disease Control and Prevention (CDC), Atlanta GA, United States of America.
Wences
W
Arvelo
Division of Global Disease Detection and Emergency Response, Centers for Disease Control and Prevention (CDC), Atlanta GA, United States of America.
Kim A
KA
Lindblade
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
John P
JP
McCracken
D000293:Adolescent; D000328:Adult; D000368:Aged; D000942:Antigens, Bacterial / Q000097:blood / Q000652:urine; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000627:therapeutic use; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D055815:Young Adult
D000942:Antigens, Bacterial; D022242:Pneumococcal Vaccines