title: Etiology of Pneumonia in a Pediatric Population with High Pneumococcal Vaccine Coverage: A Prospective Study.
abstract: BACKGROUND
  Improved Childhood Immunizations Programs, especially the introduction of pneumococcal vaccination, better diagnostic methods and the importance of reduced antibiotic misuse, make this a critical time to increase knowledge on the etiology of pediatric pneumonia. Our main objective was to identify the contribution of various microbiological species that causes pneumonia in previously healthy children and adolescents in a population with high pneumococcal conjugate vaccine coverage.
  
  
  METHODS
  This prospective, observational study enrolled patients with clinical and radiological signs of pneumonia over a 2-year period. Both inpatients and outpatients were included. Paired sera, nasopharyngeal polymerase chain reaction and bacterial cultures from blood and pleura were analyzed to detect potential viral and bacterial causative pathogens.
  
  
  RESULTS
  TWO HUNDRED AND SIXTY-FIVE: cases of clinical and radiological verified pneumonia were identified. The pneumococcal vaccine coverage was 85%. We identified a causative pathogen in 84.2% of all cases; 63.4% with single viral etiology, 11.3% with pneumococcus and 7.5% with mycoplasma infection. Respiratory syncytial virus was the most common pathogen in children younger than 5 years, whereas mycoplasma was the most common in older children.
  
  
  CONCLUSIONS
  We identified the majority of 265 cases with radiology proven pneumonia as single viral infections, predominantly respiratory syncytial virus and a much lower proportion of bacterial causes. These findings may impact pneumonia management guidelines in areas where widespread pneumococcal vaccination is provided and contribute to reduced antibiotic overuse in pediatric pneumonia.
authors.affiliation: From the *Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway; †Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway; ‡Department of Radiology and §Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway; and ¶Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Are Stuwitz
authors.initials: AS
authors.lastname: Berg
authors.forename: Christopher Stephen
authors.initials: CS
authors.lastname: Inchley
authors.forename: Audun
authors.initials: A
authors.lastname: Aase
authors.forename: Hans Olav
authors.initials: HO
authors.lastname: Fjaerli
authors.forename: Reidun
authors.initials: R
authors.lastname: Bull
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Aaberge
authors.forename: Truls Michael
authors.initials: TM
authors.lastname: Leegaard
authors.forename: Britt
authors.initials: B
authors.lastname: Nakstad
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009664:Norway / Q000453:epidemiology; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D011159:Population Surveillance; D011446:Prospective Studies; D014611:Vaccination
chemical_list: D022242:Pneumococcal Vaccines