Pneumonia epidemiology and demographics: Difference between revisions

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Latest revision as of 23:45, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2], Priyamvada Singh, M.D. [3]; Alejandro Lemor, M.D. [4]

Overview

Pneumonia is a common illness in all parts of the world. It is a major cause of death among all age groups. Mortality from pneumonia generally decreases with age until late adulthood. Elderly individuals, however, are at particular risk for pneumonia and associated mortality. More cases of pneumonia occur during the winter months than during other times of the year. Pneumonia occurs more commonly in males than females, and more often in African Americans than caucasians. People who are hospitalized for any reason are also at high risk for pneumonia. Following urinary tract infections, pneumonia is the second most common cause of nosocomial infections, and its prevalence is 15-20% of the total number.

Epidemiology and Demographics

**Table 1. Incidence of pneumococcal infections in the United States.**
Age (years)	Disease Incidence Cases/100,000 (number of cases)	Death Rate Deaths/100,000 (number of deaths)
<1	31.4 (142)	0.22 (1)
1	24.6 (112)	0.22 (1)
2-4	12.6 (171)	0.15 (2)
5-17	2.2. (111)	0.02 (1)
18-34	3.7 (261)	0.26 (18)
35-49	10.3 (670)	0.65 (42)
50-64	19.5 (1,068)	1.86 (102)
≥ 65	37.0 (1,291)	5.61 (196)
Total	12.9 (3,828)	1.22 (363)
Adapted from CDC[5]

Invasive Pneumococcal Disease Incidence by Age Group, 1998 and 2008. Obtained from CDC ^[1]

United States of America

It is the seventh most common cause of death in the United States
It causes around 500,000 hospitalizations and 65,000 deaths annually.

International

It is a common illness in all parts of the world, but countries like India, China, Pakistan, Bangladesh, Indonesia and Nigeria have high rates of childhood pneumonia.^[2]

Age

The incidence is higher in children and elderly.
In children, the majority of deaths occur in the newborn period, with over two million worldwide deaths a year.
In fact, the WHO estimates that one in three newborn infant deaths are due to pneumonia.
Mortality decreases with age until late adulthood; elderly individuals are particularly at risk for CAP and associated mortality.

Seasonal

More common during winter months than during other times of the year.

Gender

CAP occurs more commonly in males than females

Race

More common in African Americans than caucasians.

Mortality

Patients hospitalized with pneumonia have a mortality rate of 12-14%.

Special Considerations

Individuals with underlying illnesses such as Alzheimer's disease, cystic fibrosis, emphysema, tobacco smoking, alcoholism, or immune system problems are at increased risk for pneumonia.^[6]

**Countries with the highest estimated absolute number of new cases of clinical pneumonia in children**
Country	Predicted no. of new cases (millions)	Estimated incidence(e/cy)
India	43.0	0.37
China	21.1	0.22
Pakistan	9.8	0.41
Bangladesh	6.4	0.41
Nigeria	6.1	0.34
Indonesia	6.0	0.28
Ethiopia	3.9	0.35
Democratic Republic of the Congo	3.9	0.39
Viet Nam	2.9	0.35
Philippines	2.7	0.27
Sudan	2.0	0.48
Afghanistan	2.0	0.45
United Republic of Tanzania	1.9	0.33
Myanmar	1.8	0.43
Brazil	1.8	0.11
Table adapted from WHO ^[3]

Community Acquired Pneumonia

**Percentage of adults aged 65 and over who had ever received a pneumococcal vaccination: United States, 1997–2012**
Graph obtained from CDC ^[4]

As many as 400,000 hospitalizations from pneumococcal pneumonia are estimated to occur annually in the United States. Pneumococci accounts for about 30% of adult community-acquired pneumonia. ^[5]

In 2012, 59.9% of adults 65 years and older received a pneumococcal vaccination.^[6]

In 2010, the number of discharges for patient admitted with pneumonia in hospitals in the US was 1.1 million patients. The average length of stay for pneumonia patients admitted to hospitals was 5.2 days.^[6]

An increasing rate of CAP is seen with age. Approximately 5 to 6 cases of pneumonia per 1000 persons are observed among adults. A pronounced seasonal effect on the number of patients presenting to the emergency department is also noted. During the winter months, there is an approximately 50% rise in the number of cases compared to the summer months.^[7]

Streptococcus pneumoniae is the leading cause of pneumonia worldwide.^[8]

Mortality

About 3.5 million deaths yearly have been attributed to lower respiratory tract infections (LRTI). LTRIs are the third most common cause of overall death and the leading cause of death from infectious diseases worldwide.^[9]
Pneumonia is the ninth leading cause of death in the United States.
The number of deaths in the US in 2011 attributed to pneumonia was 52,294. ^[6]
Pneumonia mortality rate was 16.8 deaths per 100,000 in the US in 2011. ^[6]
A higher mortality rate is seen in invasive diseases, nursing home patients and severe bacteremia.
More than 40 % mortality rate is seen in ICU admitted patients.
The percentage of hospital inpatient deaths from pneumonia in the US 2006 was 3.4%. ^[10]

Age

Individuals older than 85 years of age are at a particularly high risk of developing CAP that can reach an annual rate of 5-10%.^[11]

Individuals younger than 3 years and older than 65 years of age are more likely to be hospitalized with severe symptoms and complications.

Gender

The risk of CAP is similar in males and females.

Incidence of Community–Acquired Pneumonia in 2010 in Children 0–4 Years of Age in 192 Countries^[12]

▸ Click on the following regions to expand the data.

Africa

Country	WHO Region	Population 0–4 years	New episodes (incidence)					New severe episodes (severe morbidity)					Deaths (mortality)
Country	WHO Region	Population 0–4 years	All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib
Algeria	AfroD	3446548	470713	34251	4697	135754	80351	53790	10297	783	7315	2251	2440	804	148
Angola	AfroD	3377576	856794	62241	9674	247099	146255	97936	18712	1613	13293	4090	20429	6733	1398
Benin	AfroD	1506408	424074	30705	5895	122303	72389	48501	9231	983	6558	2018	6281	2070	522
Burkina Faso	AfroD	2955148	1047365	76085	11826	302060	178785	119719	22874	1972	16250	5000	17933	5911	1227
Cameroon	AfroD	3054802	790160	56858	14815	227882	134880	90462	17094	2470	12143	3736	13341	4397	1463
Cape Verde	AfroD	50634	9874	691	395	2848	1686	1136	208	66	148	45	39	13	8
Chad	AfroD	2006165	678297	48155	19812	195621	115785	77827	14477	3304	10285	3164	14683	4840	2390
Comoros	AfroD	122296	38380	2769	645	11069	6552	4392	832	108	591	182	377	124	37
Equ. Guinea	AfroD	107207	16341	1144	654	4713	2789	1879	344	109	244	75	402	132	85
Gabon	AfroD	185179	36186	2579	943	10436	6177	4149	775	157	551	170	291	96	43
Gambia	AfroD	287078	79805	2667	802	23016	13623	8746	802	134	1338	412	987	171	56
Ghana	AfroD	3532887	795448	57857	8199	229407	135783	90905	17394	1367	12357	3802	7808	2573	490
Guinea	AfroD	1657883	546525	39262	10948	157618	93292	62586	11804	1826	8385	2580	7689	2534	895
Guin.–Bissau	AfroD	240350	75199	5429	1216	21687	12836	8605	1632	203	1159	357	1592	525	152
Liberia	AfroD	680701	212990	15195	5418	61426	36357	24419	4568	903	3245	999	1611	531	232
Madagascar	AfroD	3305278	1051407	76189	13932	303226	179475	120231	22906	2323	16272	5007	8004	2638	637
Mali	AfroD	2911668	932894	67350	15086	269047	159245	106745	20248	2516	14384	4426	23947	7893	2292
Mauritania	AfroD	513267	144982	10415	2904	41813	24748	16603	3131	484	2224	684	2099	692	244
Mauritius	AfroD	84433	13518	985	117	3899	2307	1544	296	20	210	65	20	7	1
Niger	AfroD	3084517	1127652	81210	20418	325215	192490	129082	24415	3405	17344	5337	19004	6264	2018
Nigeria	AfroD	26568927	7339761	513783	293590	2116787	1252897	844072	154465	48956	109729	33763	121201	39948	25767
S. Tome & P'e	AfroD	23490	5118	373	46	1476	874	585	112	8	80	25	79	26	4
Senegal	AfroD	2081483	591373	42853	7836	170552	100947	67625	12883	1307	9152	2816	4612	1520	367
Seychelles	AfroD	5623	862	63	7	248	147	98	19	1	13	4	2	1	0
Sierra Leone	AfroD	969597	315676	22866	4286	91041	53886	36101	6874	715	4883	1503	7262	2393	591
Togo	AfroD	862745	280487	20292	4082	80893	47879	32083	6101	681	4334	1333	3321	1095	288
Zimbabwe	AfroD	1692247	349031	25271	4852	100661	59580	39918	7598	809	5397	1661	2461	811	205
Botswana	AfroE	225120	47818	3347	1913	13791	8162	5499	1006	319	715	220	159	52	34
Burundi	AfroE	1184632	349477	25440	3373	100789	59656	39933	7648	562	5433	1672	7259	2393	428
Cen. Afr. Rep.	AfroE	651222	195417	13981	4538	56358	33358	22394	4203	757	2986	919	3911	1289	520
Congo	AfroE	623244	168619	12244	1959	48630	28783	19275	3681	327	2615	805	2001	659	141
Cote d'Ivoire	AfroE	2969425	985611	71421	13060	284250	168244	112707	21472	2178	15253	4693	11003	3626	875
D. Rep. Congo	AfroE	11848026	3671614	263117	80589	1058894	626745	420631	79104	13438	56194	17291	86897	28641	10986
Eritrea	AfroE	861496	208035	15163	1802	59997	35512	23766	4559	301	3238	996	2419	797	129
Ethiopia	AfroE	11931668	3367561	240540	82471	971205	574843	386005	72317	13752	51372	15807	37269	12284	5196
Kenya	AfroE	6664323	1645189	119118	22871	474473	280834	188157	35812	3814	25440	7828	17064	5624	1419
Lesotho	AfroE	274307	58335	4224	811	16824	9958	6672	1270	135	902	278	607	200	50
Malawi	AfroE	2714859	658512	47877	7004	189915	112408	75261	14394	1168	10225	3146	6932	2285	448
Mozambique	AfroE	3876419	1155781	83373	19438	333327	197292	132266	25065	3241	17806	5479	13167	4340	1307
Namibia	AfroE	286374	63796	4619	887	18399	10890	7296	1389	148	987	304	287	95	24
Rwanda	AfroE	1830654	397910	13638	3991	114757	67923	43646	4100	666	6659	2049	4145	734	236
South Africa	AfroE	5041132	705554	33436	14342	203482	120438	78749	10052	2392	11357	3494	5156	1218	583
Swaziland	AfroE	156715	28802	2091	344	8306	4916	3293	629	57	446	137	471	155	34
Uganda	AfroE	6465275	1745727	126241	25969	503468	297996	199697	37953	4330	26961	8296	21181	6981	1876
U. R. Tanzania	AfroE	8009544	2151379	156285	24291	620458	367240	245913	46986	4051	33378	10270	17467	5757	1195
Zambia	AfroE	2412190	576056	41709	8008	166135	98333	65882	12539	1335	8908	2741	6141	2024	511
ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus

America

Country	WHO Region	Population 0–4 years	New episodes (incidence)					New severe episodes (severe morbidity)					Deaths (mortality)
Country	WHO Region	Population 0–4 years	All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib
Canada	AmroA	1884546	25275	866	271	13709	8032	6438	604	105	3774	755	27	5	2
Cuba	AmroA	569056	8208	598	79	4452	2609	2178	417	31	1140	228	63	21	4
USA	AmroA	21650217	313322	22733	3845	169946	99574	83169	15868	1489	43355	8671	799	263	59
Antigua & B'a	AmroB	7756	686	50	6	198	117	78	15	1	41	8	0	0	0
Argentina	AmroB	3385831	311588	22663	3212	89862	53188	35609	6814	536	18616	3723	952	314	60
Bahamas	AmroB	25507	2514	182	23	725	429	287	55	4	151	30	25	8	1
Barbados	AmroB	14562	1377	60	19	397	235	153	18	3	87	17	4	1	0
Belize	AmroB	36599	4795	349	46	1383	819	548	105	8	287	57	9	3	1
Brazil	AmroB	15156449	1497706	95518	14711	431938	255658	169535	28717	2453	91150	18230	3079	916	181
Chile	AmroB	1219437	88722	6448	973	25588	15145	10141	1938	162	5296	1059	145	48	10
Colombia	AmroB	4497661	488486	31421	6092	140879	83385	55372	9446	1016	29585	5917	1530	459	113
Costa Rica	AmroB	362979	37185	1272	425	10724	6348	4080	382	71	2389	478	24	4	2
Dominica	AmroB	5924	703	51	6	203	120	80	15	1	42	8	0	0	0
ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus

Europe

Country	WHO Region	Population 0–4 years	New episodes (incidence)					New severe episodes (severe morbidity)					Deaths (mortality)
Country	WHO Region	Population 0–4 years	All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib
Andorra	EuroA	4001	58	4	1	31	18	15	3	0	9	2	0	0	0
Austria	EuroA	386431	5604	406	78	3040	1781	1488	283	30	913	186	5	2	0
Belgium	EuroA	616259	8882	647	80	4817	2823	2356	452	31	1456	296	7	2	0
Croatia	EuroA	389100	5610	409	52	3043	1783	1488	285	20	919	187	8	2	0
Czech Rep.	EuroA	547804	7892	575	68	4280	2508	2093	401	26	1294	263	23	7	1
Denmark	EuroA	326007	4413	168	55	2394	1402	1129	117	21	770	157	5	1	0
Estonia	EuroA	78229	1129	82	12	613	359	300	57	5	185	38	2	1	0
Finland	EuroA	299477	4314	314	37	2340	1371	1144	219	14	708	144	7	2	0
France	EuroA	3974436	53589	2019	534	29067	17031	13698	1409	207	9391	1910	61	12	3
Germany	EuroA	3466740	49718	3450	516	26967	15800	13146	2408	200	8192	1666	67	21	4
Greece	EuroA	586137	8500	615	118	4610	2701	2257	430	46	1385	282	35	12	3
Hungary	EuroA	490804	7071	515	61	3835	2247	1875	360	24	1160	236	27	9	1
Iceland	EuroA	23511	339	25	3	184	108	90	17	1	56	11	0	0	0
Ireland	EuroA	358318	5011	282	53	2718	1592	1307	197	21	847	172	4	1	0
Israel	EuroA	735243	10618	772	113	5759	3375	2818	539	44	1737	353	13	4	1
Italy	EuroA	2901653	41871	3047	418	22711	13307	11109	2127	162	6856	1395	30	10	2
Luxembourg	EuroA	28783	389	15	4	211	124	100	11	1	68	14	0	0	0
Malta	EuroA	19130	278	20	4	151	88	74	14	2	45	9	0	0	0
Monaco	EuroA	2001	29	2	0	16	9	8	1	0	5	1	0	0	0
Netherlands	EuroA	934218	12528	435	126	6795	3981	3192	303	49	2208	449	18	3	1
Norway	EuroA	303047	4085	150	45	2216	1298	1044	105	17	716	146	3	1	0
Poland	EuroA	1933388	27852	2030	241	15107	8851	7388	1417	93	4568	929	126	41	7
Portugal	EuroA	516604	7448	542	69	4040	2367	1976	379	27	1221	248	3	1	0
San Marino	EuroA	1401	20	1	0	11	6	5	1	0	3	1	0	0	0
Serbia & Montenegro	EuroA	604144	8747	634	110	4744	2780	2322	443	43	1428	290	30	10	2
Slovakia	EuroA	275895	3688	123	34	2000	1172	938	86	13	652	133	35	6	2
Slovenia	EuroA	99368	1433	104	14	777	455	380	73	5	235	48	2	1	0
Spain	EuroA	2521375	36353	2647	339	19718	11553	9644	1848	131	5958	1212	50	16	3
Sweden	EuroA	557426	7682	382	72	4167	2441	1989	266	28	1317	268	10	2	1
Switzerland	EuroA	376228	5431	395	56	2946	1726	1441	276	22	889	181	3	1	0
UK	EuroA	3765820	50844	1913	560	27578	16158	13000	1335	217	8898	1810	165	32	10
Albania	EuroB	207681	6230	436	249	3379	1980	1664	304	96	981	200	66	22	14
Bosnia & Herzegovina	EuroB	164958	4784	346	67	2595	1520	1270	242	26	780	159	24	8	2
Bulgaria	EuroB	373095	10245	470	122	5557	3256	2643	328	47	1763	359	219	50	15
Georgia	EuroB	256459	7488	539	143	4061	2380	1990	376	55	1212	247	108	36	12
Romania	EuroB	1079244	32377	2266	1295	17561	10290	8645	1582	501	5100	1037	807	266	172
FYR Macedonia	EuroB	111863	3236	235	39	1755	1029	859	164	15	529	108	10	3	1
Turkey	EuroB	6412702	172393	6203	1724	93506	54786	43984	4330	667	30306	6164	2212	408	126
Armenia	EuroB	226376	6661	475	167	3613	2117	1773	332	65	1070	218	80	26	11
Azerbaijan	EuroB	795163	23855	1670	954	12939	7581	6369	1166	369	3758	764	1448	477	308
Kyrgyzstan	EuroB	595111	17168	1250	166	9312	5456	4555	872	64	2812	572	599	197	35
Tajikistan	EuroB	870519	25144	1828	267	13638	7991	6672	1276	104	4114	837	2097	691	136
Turkmenistan	EuroB	505844	14823	1062	325	8040	4711	3943	741	126	2391	486	824	271	104
Uzbekistan	EuroB	2737750	82133	5749	3285	44549	26102	21929	4013	1272	12938	2632	4970	1638	1057
Belarus	EuroC	514996	30900	2163	1236	16760	9820	8250	1510	479	4868	990	51	17	11
Kazakhstan	EuroC	1640953	94676	6892	914	51352	30088	25117	4811	354	15510	3155	1408	464	83
Latvia	EuroC	115275	6673	484	82	3619	2121	1771	338	32	1090	222	19	6	1
Lithuania	EuroC	166177	9592	698	96	5203	3048	2545	487	37	1571	319	19	6	1
R. of Moldova	EuroC	214693	12557	902	256	6811	3991	3339	629	99	2029	413	161	53	19
Russian Federation	EuroC	8117113	487027	34092	19481	264163	154777	130036	23797	7542	76721	15604	1618	533	344
Ukraine	EuroC	2376293	139669	9980	3376	75756	44387	37167	6966	1307	22460	4568	629	207	87
ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus

South-East Asia Region

Country	WHO Region	Population 0–4 years	New episodes (incidence)					New severe episodes (severe morbidity)					Deaths (mortality)
Country	WHO Region	Population 0–4 years	All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib
Indonesia	SearoB	21578876	3918360	274285	156734	1130055	668864	450611	82462	26135	99135	22531	19147	6311	4071
Sri Lanka	SearoB	1892699	433688	31610	3757	125076	74030	49545	9503	626	11425	2597	298	98	16
Thailand	SearoB	4360687	648021	45361	25921	186889	110617	74522	13638	4322	16395	3726	903	298	192
Timor Leste	SearoB	192839	67370	4716	2695	19429	11500	7748	1418	449	1704	387	489	161	104
Bangladesh	SearoD	14707333	4484527	326317	44752	1293338	765509	512461	98105	7462	117940	26805	18310	6035	1114
Bhutan	SearoD	70891	12773	894	511	3684	2180	1469	269	85	323	73	152	50	32
DPR of Korea	SearoD	1704446	393494	27545	15740	113484	67169	45252	8281	2625	9955	2263	1744	575	371
India	SearoD	127960004	35361230	2475286	1414449	10198179	6036162	4066541	744177	235859	894639	203327	388144	127932	82519
Maldives	SearoD	25984	4061	284	162	1171	693	467	85	27	103	23	6	2	1
Myanmar	SearoD	3956305	1213300	84931	48532	349916	207110	139530	25534	8093	30697	6976	9129	3009	1941
Nepal	SearoD	3506023	832451	58272	33298	240079	142099	95732	17519	5552	21061	4787	5501	1813	1170
ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus

Western Pacific Region

Country	WHO Region	Population 0–4 years	New episodes (incidence)					New severe episodes (severe morbidity)					Deaths (mortality)
Country	WHO Region	Population 0–4 years	All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib
Australia	WproA	1457527	32776	1204	385	17778	10416	8374	841	149	2724	1654	38	7	3
Brunei D'lam	WproA	37385	899	65	9	488	286	239	46	3	70	42	3	1	0
Japan	WproA	5430793	135770	9504	5431	73642	43148	36251	6634	2103	10150	6163	231	76	49
New Zealand	WproA	311974	7036	264	90	3816	2236	1800	184	35	583	354	31	6	2
Singapore	WproA	230550	5764	403	231	3126	1832	1539	282	89	431	262	9	3	2
Cambodia	WproB	1491690	373583	27150	4096	107741	63771	42699	8162	683	12489	7583	2101	693	140
China	WproB	81595595	6488544	454198	259542	1871296	1107594	746183	136551	43279	208931	126851	43089	14202	9161
Cook Islands	WproB	2096	210	15	2	61	36	24	5	0	7	4	0	0	0
Fiji	WproB	89552	14426	1051	125	4161	2463	1648	316	21	484	294	30	10	2
Kiribati	WproB	9948	1625	118	18	469	277	186	35	3	54	33	19	6	1
Lao Peop's DR	WproB	682861	212441	15325	3573	61268	36264	24312	4607	596	7049	4280	1076	355	107
Malaysia	WproB	2828151	285716	20781	2945	82400	48772	32652	6248	491	9559	5804	199	66	12
Marshall Isl.	WproB	5400	934	59	10	269	159	106	18	2	32	19	5	2	0
Micronesia	WproB	13237	2620	118	50	756	447	292	35	8	91	55	23	5	2
Mongolia	WproB	296799	60292	4389	582	17388	10292	6889	1320	97	2019	1226	332	109	20
Nauru	WproB	1025	97	7	1	28	16	11	2	0	3	2	1	0	0
Niue	WproB	152	15	1	0	4	3	2	0	0	1	0	0	0	0
Palau	WproB	2046	211	12	4	61	36	24	3	1	7	4	0	0	0
Papua N. G.	WproB	962437	166267	11905	3755	47951	28382	19051	3579	626	5476	3325	2038	672	264
Philippines	WproB	11254421	2428448	170059	96399	700364	414536	279254	51127	16075	78227	47495	8974	2958	1896
R. of Korea	WproB	2371820	249811	17487	9992	72045	42643	28728	5257	1666	8044	4884	56	18	12
Samoa	WproB	22338	3377	245	43	974	576	386	74	7	113	68	7	2	1
Solomon Isl.	WproB	79962	19101	1381	290	5509	3261	2185	415	48	635	386	59	20	5
Tonga	WproB	13792	2223	162	19	641	379	254	49	3	75	45	4	1	0
Tuvalu	WproB	1015	126	9	2	36	22	14	3	0	4	3	0	0	0
Vanuatu	WproB	33152	8344	584	334	2406	1424	960	176	56	269	163	9	3	2
Vietnam	WproB	7185862	1728193	124101	35174	498411	295003	197920	37310	5865	57086	34660	3553	1171	420
ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus

Eastern Mediterranean

Country	WHO Region	Population 0–4 years	New episodes (incidence)					New severe episodes (severe morbidity)					Deaths (mortality)
Country	WHO Region	Population 0–4 years	All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib	RSV	FLU	All ALRI	SP	Hib
Bahrain	EmroB	93006	9763	327	91	2816	1667	1070	98	15	227	101	5	1	0
Cyprus	EmroB	63553	7253	528	70	2092	1238	829	159	12	156	69	1	0	0
Iran (Isl. Rep.)	EmroB	6149331	729564	51069	29183	210406	124537	83900	15354	4866	15102	6712	4168	1374	886
Jordan	EmroB	816013	87843	6400	790	25334	14995	10036	1924	132	1893	841	268	88	15
Kuwait	EmroB	281414	29357	994	284	8467	5011	3218	299	47	681	303	38	7	2
Lebanon	EmroB	321684	35518	2569	517	10243	6063	4063	773	86	760	338	49	16	4
Libyan A. J.	EmroB	715540	80748	5883	726	23288	13784	9225	1769	121	1740	773	60	20	3
Oman	EmroB	281883	32111	1074	300	9261	5481	3518	323	50	746	332	25	4	1
Qatar	EmroB	90524	9669	331	97	2788	1650	1061	100	16	224	100	4	1	0
Saudi Arabia	EmroB	3145187	337985	11445	3273	97475	57694	37052	3441	546	7842	3485	372	65	20
Syrian A. R.	EmroB	2493561	280849	20309	4178	80997	47941	32127	6106	697	6006	2669	572	189	51
Tunisia	EmroB	868231	99837	6989	3993	28793	17042	11481	2101	666	2067	919	209	69	44
U. A. Emir.	EmroB	420630	46752	1660	517	13483	7981	5137	499	86	1079	480	14	3	1
Afghanistan	EmroD	5545968	2040302	146694	39565	588423	348280	233617	44102	6598	43379	19280	30913	10189	3494
Djibouti	EmroD	113169	24926	1808	306	7189	4255	2850	544	51	535	238	446	147	33
Egypt	EmroD	9008118	680363	47625	27215	196217	116138	78242	14318	4538	14084	6259	4765	1570	1013
Iraq	EmroD	5188175	893131	62519	35725	257579	152457	102710	18796	5957	18488	8217	7568	2494	1609
Morocco	EmroD	3021924	385554	27959	3343	111194	65814	44029	8406	557	8316	3696	3103	1019	165
Pakistan	EmroD	21418111	6728235	487755	86960	1940423	1148510	769337	146640	14501	144236	64105	64853	21376	5039
Somalia	EmroD	1667479	650669	45547	26027	187653	111069	74827	13693	4340	13469	5986	18089	5962	3846
Sudan	EmroD	6391368	2061300	148754	34001	594479	351864	235876	44722	5670	43989	19550	26894	8864	3681
Yemen	EmroD	4057096	1150463	83436	14494	331793	196384	131540	25084	2417	24673	10966	15193	5008	1152
ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus

Hospital Acquired Pneumonia

Pneumonia has accounted for approximately 20% of all hospital-associated infections and 27% and 24% of all infections acquired in the medical intensive-care unit (ICU) and coronary care unit, respectively. ^[13]

Incidence

The incidence of HAP is 5-15 cases per 1 000 hospital admissions. ^[14]
The incidence of VAP is 6 to 20 times more than in patients without mechanical support.


Age	Females	Males

18-44 years	5%	4%
45-64 years	14%	13%
≥ 65 years	34%	30%
Total	53%	47%
Table adapted from 2009–2011 National Medicare Patient Safety Monitoring System ^[15]

Mortality

HAP and VAP are nosocomial infections with a high mortality in contrast with other nosocomial infections.
This higher mortality rate is associated with MDR pathogens.

Age

HAP is more commonly reported in patients > 65 years, probably due to the fact that this age population is more commonly hospitalized.

Gender

There is no predominance in gender, although some data reports a higher incidence among females.

Ventilator-associated Pneumonia

VAP occurs in up to 25% of all people who require mechanical ventilation.
VAP can develop at any time during ventilation, but occurs more often in the first few days after intubation.
This is because the intubation process itself contributes to the development of VAP.
VAP occurring early after intubation typically involves fewer resistant organisms and is thus associated with a more favorable outcome.
Because respiratory failure requiring mechanical ventilation is itself associated with a high mortality, determination of the exact contribution of VAP to mortality has been difficult.
As of 2006, estimates range from 33% to 50% death in patients who develop VAP.
Mortality is more likely when VAP is associated with certain microorganisms (Pseudomonas, Acinetobacter), blood stream infections, and ineffective initial antibiotics.
VAP is especially common in people who have acute respiratory distress syndrome (ARDS).

References

↑ "Pneumococcal Disease - Epidemiology and Prevention of Vaccine-Preventable Diseases".
↑ Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H (2008). "Epidemiology and etiology of childhood pneumonia". Bull World Health Organ. 86 (5): 408–16. PMC 2647437. PMID 18545744.
↑ http://www.who.int/bulletin/volumes/86/5/07-048769-table-T2.html
↑ "CDC Early Release of Selected Estimates Based on Data From the 2012 National Health Interview Survey - Receipt of pneumococcal vaccination" (PDF).
↑ "CDC Pneumococcal Disease - Clinical Features".
↑ ^6.0 ^6.1 ^6.2 ^6.3 "CDC Pneumonia FastStats".
↑ Marrie, TJ.; Huang, JQ. (2005). "Epidemiology of community-acquired pneumonia in Edmonton, Alberta: an emergency department-based study". Can Respir J. 12 (3): 139–42. PMID 15875065. Unknown parameter |month= ignored (help)
↑ Miniño, AM.; Murphy, SL.; Xu, J.; Kochanek, KD. (2011). "Deaths: final data for 2008". Natl Vital Stat Rep. 59 (10): 1–126. PMID 22808755. Unknown parameter |month= ignored (help)
↑ "WHO". Text " The top 10 causes of death " ignored (help)
↑ http://www.cdc.gov/nchs/data/series/sr_13/sr13_168.pdf
↑ Jackson ML, Neuzil KM, Thompson WW, Shay DK, Yu O, Hanson CA; et al. (2004). "The burden of community-acquired pneumonia in seniors: results of a population-based study". Clin Infect Dis. 39 (11): 1642–50. doi:10.1086/425615. PMID 15578365.
↑ Rudan I, O'Brien KL, Nair H, Liu L, Theodoratou E, Qazi S; et al. (2013). "Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries". J Glob Health. 3 (1): 010401. doi:10.7189/jogh.03.010401. PMC 3700032. PMID 23826505.
↑ Magill, Shelley S.; Edwards, Jonathan R.; Bamberg, Wendy; Beldavs, Zintars G.; Dumyati, Ghinwa; Kainer, Marion A.; Lynfield, Ruth; Maloney, Meghan; McAllister-Hollod, Laura; Nadle, Joelle; Ray, Susan M.; Thompson, Deborah L.; Wilson, Lucy E.; Fridkin, Scott K. (2014). "Multistate Point-Prevalence Survey of Health Care–Associated Infections". New England Journal of Medicine. 370 (13): 1198–1208. doi:10.1056/NEJMoa1306801. ISSN 0028-4793.
↑ "Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia". American Journal of Respiratory and Critical Care Medicine. 171 (4): 388–416. 2005. doi:10.1164/rccm.200405-644ST. ISSN 1073-449X.
↑ Eckenrode, Sheila; Bakullari, Anila; Metersky, Mark L.; Wang, Yun; Pandolfi, Michelle M.; Galusha, Deron; Jaser, Lisa; Eldridge, Noel (2014). "The Association between Age, Sex, and Hospital-Acquired Infection Rates: Results from the 2009–2011 National Medicare Patient Safety Monitoring System". Infection Control and Hospital Epidemiology. 35 (S3): S3–S9. doi:10.1086/677831. ISSN 0899-823X.

Template:WH Template:WS

[1] "Pneumococcal Disease - Epidemiology and Prevention of Vaccine-Preventable Diseases".

[pmid18545744-2] Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H (2008). "Epidemiology and etiology of childhood pneumonia". Bull World Health Organ. 86 (5): 408–16. PMC 2647437. PMID 18545744.

[3] ttp://www.who.int/bulletin/volumes/86/5/07-048769-table-T2.html

[4] "CDC Early Release of Selected Estimates Based on Data From the 2012 National Health Interview Survey - Receipt of pneumococcal vaccination" (PDF).

[5] "CDC Pneumococcal Disease - Clinical Features".

[CDC-6] 6.0 ^6.1 ^6.2 ^6.3 "CDC Pneumonia FastStats".

[Marrie-2005-7] Marrie, TJ.; Huang, JQ. (2005). "Epidemiology of community-acquired pneumonia in Edmonton, Alberta: an emergency department-based study". Can Respir J. 12 (3): 139–42. PMID 15875065. Unknown parameter |month= ignored (help)

[Miniño-2011-8] Miniño, AM.; Murphy, SL.; Xu, J.; Kochanek, KD. (2011). "Deaths: final data for 2008". Natl Vital Stat Rep. 59 (10): 1–126. PMID 22808755. Unknown parameter |month= ignored (help)

[www.who.int-9] "WHO". Text " The top 10 causes of death " ignored (help)

[10] ttp://www.cdc.gov/nchs/data/series/sr_13/sr13_168.pdf

[pmid15578365-11] Jackson ML, Neuzil KM, Thompson WW, Shay DK, Yu O, Hanson CA; et al. (2004). "The burden of community-acquired pneumonia in seniors: results of a population-based study". Clin Infect Dis. 39 (11): 1642–50. doi:10.1086/425615. PMID 15578365.

[pmid23826505-12] Rudan I, O'Brien KL, Nair H, Liu L, Theodoratou E, Qazi S; et al. (2013). "Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries". J Glob Health. 3 (1): 010401. doi:10.7189/jogh.03.010401. PMC 3700032. PMID 23826505.

[MagillEdwards2014-13] Magill, Shelley S.; Edwards, Jonathan R.; Bamberg, Wendy; Beldavs, Zintars G.; Dumyati, Ghinwa; Kainer, Marion A.; Lynfield, Ruth; Maloney, Meghan; McAllister-Hollod, Laura; Nadle, Joelle; Ray, Susan M.; Thompson, Deborah L.; Wilson, Lucy E.; Fridkin, Scott K. (2014). "Multistate Point-Prevalence Survey of Health Care–Associated Infections". New England Journal of Medicine. 370 (13): 1198–1208. doi:10.1056/NEJMoa1306801. ISSN 0028-4793.

[14] "Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia". American Journal of Respiratory and Critical Care Medicine. 171 (4): 388–416. 2005. doi:10.1164/rccm.200405-644ST. ISSN 1073-449X.

[EckenrodeBakullari2014-15] Eckenrode, Sheila; Bakullari, Anila; Metersky, Mark L.; Wang, Yun; Pandolfi, Michelle M.; Galusha, Deron; Jaser, Lisa; Eldridge, Noel (2014). "The Association between Age, Sex, and Hospital-Acquired Infection Rates: Results from the 2009–2011 National Medicare Patient Safety Monitoring System". Infection Control and Hospital Epidemiology. 35 (S3): S3–S9. doi:10.1086/677831. ISSN 0899-823X.

[1]

[2]

[6]

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[4]

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[14]

[15]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Pneumonia}}
-{{CMG}}; {{AE}} [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com]; {{AL}}
+{{CMG}}; {{AE}} {{HQ}}, [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com]; {{AL}}
 ==Overview==
 Pneumonia is a common illness in all parts of the world. It is a major cause of death among all age groups. Mortality from pneumonia generally decreases with age until late adulthood. Elderly individuals, however, are at particular risk for pneumonia and associated mortality. More cases of pneumonia occur during the winter months than during other times of the year. Pneumonia occurs more commonly in males than females, and more often in African Americans than caucasians.  People who are hospitalized for any reason are also at high risk for pneumonia. Following [[urinary tract infection]]s, pneumonia is the second most common cause of [[nosocomial infection]]s, and its prevalence is 15-20% of the total number.
 ==Epidemiology and Demographics==
+{| style="float:right"
+|
 {{#widget:BlueTable}}
-{|class="BlueTable" style="width:420px; font-size:95%;float:right"
+{| class="BlueTable" style="width:420px; font-size:95%;float:right"
 |+'''Table 1. Incidence of pneumococcal infections in the United States.'''
-! align="center; width:100px"|'''Age (years)'''
+! align="center; width:100px" |'''Age (years)'''
-! align="center; width:200px"|'''Disease Incidence Cases/100,000 (number of cases)'''
+! align="center; width:200px" |'''Disease Incidence Cases/100,000 (number of cases)'''
-! align="center; width:200px"|'''Death Rate Deaths/100,000 (number of deaths)'''
+! align="center; width:200px" |'''Death Rate Deaths/100,000 (number of deaths)'''
 |-
 | '''<1'''||31.4 (142)||0.22 (1)
@@ Line 32: / Line 33: @@
 | '''Total'''||12.9 (3,828)||1.22 (363)
 |-
-|colspan=3| Adapted from CDC[http://www.cdc.gov/vaccines/pubs/surv-manual/chpt11-pneumo.html]
+| colspan="3" | Adapted from CDC[http://www.cdc.gov/vaccines/pubs/surv-manual/chpt11-pneumo.html]
+|}
+|-
+|
+{|
+|[[Image:Invasive Pneumococcal Disease Incidence by Age Group, 1998 and 2008.jpg|thumb|550px|Invasive Pneumococcal Disease Incidence by Age Group, 1998 and 2008.  <small>Obtained from CDC <ref>{{cite web|url=http://www.cdc.gov/vaccines/pubs/pinkbook/pneumo.html| title=Pneumococcal Disease - Epidemiology and Prevention of Vaccine-Preventable Diseases }}</ref></small>]]
+|}
 |}
 ===United States of America===
@@ Line 39: / Line 46: @@
 ===International===
-* It is a common illness in all parts of the world.
+* It is a common illness in all parts of the world, but countries like  India, China, Pakistan, Bangladesh, Indonesia and Nigeria have high rates of childhood pneumonia.<ref name="pmid18545744">{{cite journal| author=Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H| title=Epidemiology and etiology of childhood pneumonia. | journal=Bull World Health Organ | year= 2008 | volume= 86 | issue= 5 | pages= 408-16 | pmid=18545744 | doi= | pmc=PMC2647437 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18545744  }} </ref>
 ===Age===
-* It is a major cause of death among all age groups.
+* The incidence is higher in children and elderly.
 * In children, the majority of deaths occur in the newborn period, with over two million worldwide deaths a year.
-* In fact, the WHO estimates that one in three newborn infant deaths are due to pneumonia.{{ref|Garenne}}
+* In fact, the WHO estimates that one in three newborn infant deaths are due to pneumonia.
 * Mortality decreases with age until late adulthood; elderly individuals are particularly at risk for CAP and associated mortality.
@@ Line 58: / Line 66: @@
 ===Special Considerations===
 * Individuals with underlying illnesses such as [[Alzheimer's disease]], [[cystic fibrosis]], [[emphysema]], [[tobacco smoking]], [[alcoholism]], or [[immunosuppression|immune system problems]] are at increased risk for pneumonia.{{ref|Almirall}}
-{|style="float:right"
-|[[Image:Invasive Pneumococcal Disease Incidence by Age Group, 1998 and 2008.jpg|thumb|550px|Invasive Pneumococcal Disease Incidence by Age Group, 1998 and 2008.  <small>Obtained from CDC <ref>{{cite web|url=http://www.cdc.gov/vaccines/pubs/pinkbook/pneumo.html| title=Pneumococcal Disease - Epidemiology and Prevention of Vaccine-Preventable Diseases }}</ref></small>]]
-|}
 <small>
 {{#widget:BlueTable}}
@@ Line 98: / Line 102: @@
 | Brazil||1.8||0.11
 |-
-|colspan=3|<small> Table adapted from WHO <ref>http://www.who.int/bulletin/volumes/86/5/07-048769-table-T2.html</ref></small>
+| colspan="3" |<small> Table adapted from WHO <ref>http://www.who.int/bulletin/volumes/86/5/07-048769-table-T2.html</ref></small>
 |}</small>
-==Incidence of Community–Acquired Pneumonia in 2010 in Children 0–4 Years of Age in 192 Countries<ref name="pmid23826505">{{cite journal| author=Rudan I, O'Brien KL, Nair H, Liu L, Theodoratou E, Qazi S et al.| title=Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries. | journal=J Glob Health | year= 2013 | volume= 3 | issue= 1 | pages= 010401 | pmid=23826505 | doi=10.7189/jogh.03.010401 | pmc=PMC3700032 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23826505 }} </ref>==
+==Community Acquired Pneumonia==
+{| style="float:right"
+|[[File:Percentage_of_adults_aged_65_and_over_who_had_ever_received_a_pneumococcal_vaccination_United_States,_1997–2012.png|thumb|450px|''' Percentage of adults aged 65 and over who had ever received a pneumococcal vaccination: United States, 1997–2012'''<br> Graph obtained from CDC <ref>{{cite web|url=http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201306_05.pdf |title=CDC Early Release of Selected Estimates Based on Data From the 2012 National Health Interview Survey - Receipt of pneumococcal vaccination}}</ref>]]
+|}
+*As many as 400,000 hospitalizations from pneumococcal pneumonia are estimated to occur annually in the United States. Pneumococci accounts for about 30% of adult community-acquired pneumonia. <ref>{{cite web|url=http://www.cdc.gov/pneumococcal/clinicians/clinical-features.html| title= CDC Pneumococcal Disease - Clinical Features}} </ref>
+*In 2012, 59.9% of adults 65 years and older received a pneumococcal vaccination.<ref name="CDC">{{cite web|url=http://www.cdc.gov/nchs/fastats/pneumonia.htm| title=CDC Pneumonia FastStats}} </ref>
+*In 2010, the number of discharges for patient admitted with pneumonia in hospitals in the US was 1.1 million patients.  The average length of stay for pneumonia patients admitted to hospitals was 5.2 days.<ref name="CDC">{{cite web|url=http://www.cdc.gov/nchs/fastats/pneumonia.htm| title=CDC Pneumonia FastStats}} </ref>
+*An increasing rate of CAP is seen with age. Approximately 5 to 6 cases of [[pneumonia]] per 1000 persons are observed among adults. A pronounced seasonal effect on the number of patients presenting to the emergency department is also noted. During the winter months, there is an approximately 50% rise in the number of cases compared to the summer months.<ref name="Marrie-2005">{{Cite journal  | last1 = Marrie | first1 = TJ. | last2 = Huang | first2 = JQ. | title = Epidemiology of community-acquired pneumonia in Edmonton, Alberta: an emergency department-based study. | journal = Can Respir J | volume = 12 | issue = 3 | pages = 139-42 | month = Apr | year = 2005 | doi =  | PMID = 15875065 }}</ref>
+*''[[Streptococcus pneumoniae]]'' is the leading cause of [[pneumonia]] worldwide.<ref name="Miniño-2011">{{Cite journal  | last1 = Miniño | first1 = AM. | last2 = Murphy | first2 = SL. | last3 = Xu | first3 = J. | last4 = Kochanek | first4 = KD. | title = Deaths: final data for 2008. | journal = Natl Vital Stat Rep | volume = 59 | issue = 10 | pages = 1-126 | month = Dec | year = 2011 | doi =  | PMID = 22808755 }}</ref>
+===Mortality===
+* About 3.5 million deaths yearly have been attributed to [[lower respiratory tract infection]]s (LRTI). LTRIs are the third most common cause of overall death and the leading cause of death from infectious diseases worldwide.<ref name="www.who.int">{{Cite web  | last =  | first =  | title = WHO | The top 10 causes of death | url = http://www.who.int/mediacentre/factsheets/fs310/en/index.html | publisher =  | date =  | accessdate =  }}</ref>
+* [[Pneumonia]] is the ninth leading cause of death in the United States.
+* The number of deaths in the US in 2011 attributed to pneumonia was 52,294. <ref name="CDC">{{cite web|url=http://www.cdc.gov/nchs/fastats/pneumonia.htm| title=CDC Pneumonia FastStats}} </ref>
+* Pneumonia mortality rate was 16.8 deaths per 100,000 in the US in 2011.  <ref name="CDC">{{cite web|url=http://www.cdc.gov/nchs/fastats/pneumonia.htm| title=CDC Pneumonia FastStats}} </ref>
+* A higher mortality rate is seen in invasive diseases, nursing home patients and severe [[bacteremia]].
+* More than 40 % mortality rate is seen in ICU admitted patients.
+* The percentage of hospital inpatient deaths from pneumonia in the US 2006 was 3.4%. <ref>http://www.cdc.gov/nchs/data/series/sr_13/sr13_168.pdf</ref>
+===Age===
+*Individuals older than 85 years of age are at a particularly high risk of developing CAP that can reach an annual rate of 5-10%.<ref name="pmid15578365">{{cite journal| author=Jackson ML, Neuzil KM, Thompson WW, Shay DK, Yu O, Hanson CA et al.| title=The burden of community-acquired pneumonia in seniors: results of a population-based study. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 11 | pages= 1642-50 | pmid=15578365 | doi=10.1086/425615 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15578365  }} </ref>
+*Individuals younger than 3 years and older than 65 years of age are more likely to be hospitalized with severe symptoms and complications.
+===Gender===
+*The risk of CAP is similar in males and females.
+===Incidence of Community–Acquired Pneumonia in 2010 in Children 0–4 Years of Age in 192 Countries<ref name="pmid23826505">{{cite journal| author=Rudan I, O'Brien KL, Nair H, Liu L, Theodoratou E, Qazi S et al.| title=Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries. | journal=J Glob Health | year= 2013 | volume= 3 | issue= 1 | pages= 010401 | pmid=23826505 | doi=10.7189/jogh.03.010401 | pmc=PMC3700032 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23826505 }} </ref>===
 {{#widget:BlueTable}}
 <SMALL><font color="#4479BA">'''▸ Click on the following regions to expand the data.'''</font></SMALL>
 <div class="mw-customtoggle-table1" style="cursor:pointer; border-radius: 5px 5px 5px 5px; border: solid 2px #4479BA; box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: white; height: 30px; line-height: 30px; width: 200px;padding: 5px 5px;text-align:center; font-size: 120%">'''Africa'''</div>
-{|class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table1"
+{| class="mw-collapsible mw-collapsed"
 |
 {{#widget:BlueTable}}
-{|class="BlueTable" style="font-size:95%"
+{| class="BlueTable" style="font-size:95%"
-!rowspan=2|Country
+! rowspan="2" |Country
-!rowspan=2|WHO Region
+! rowspan="2" |WHO Region
-!rowspan=2|Population 0–4 years
+! rowspan="2" |Population 0–4 years
-!colspan=5|New episodes (incidence)
+! colspan="5" |New episodes (incidence)
-!colspan=5|New severe episodes (severe morbidity)
+! colspan="5" |New severe episodes (severe morbidity)
-!colspan=3|Deaths (mortality)
+! colspan="3" |Deaths (mortality)
 |-
 ! |All ALRI||SP||Hib||RSV||FLU||All ALRI||SP||Hib||RSV||FLU||All ALRI||SP||Hib
@@ Line 211: / Line 246: @@
 | Zambia||AfroE||2412190||576056||41709||8008||166135||98333||65882||12539||1335||8908||2741||6141||2024||511
 |-
-|colspan=16 |<small>'''ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus'''</small>
+| colspan="16" |<small>'''ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus'''</small>
 |}
 |}
 <div class="mw-customtoggle-table2" style="cursor:pointer; border-radius: 5px 5px 5px 5px; border: solid 2px #4479BA; box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: white; height: 30px; line-height: 30px; width: 200px;padding: 5px 5px;text-align:center; font-size: 120%">'''America'''</div>
-{|class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table2"
+{| class="mw-collapsible mw-collapsed"
 |
-{|class="BlueTable" style="font-size:95%"
+{| class="BlueTable" style="font-size:95%"
-!rowspan=2|Country
+! rowspan="2" |Country
-!rowspan=2|WHO Region
+! rowspan="2" |WHO Region
-!rowspan=2|Population 0–4 years
+! rowspan="2" |Population 0–4 years
-!colspan=5|New episodes (incidence)
+! colspan="5" |New episodes (incidence)
-!colspan=5|New severe episodes (severe morbidity)
+! colspan="5" |New severe episodes (severe morbidity)
-!colspan=3|Deaths (mortality)
+! colspan="3" |Deaths (mortality)
 |-
 ! |All ALRI||SP||Hib||RSV||FLU||All ALRI||SP||Hib||RSV||FLU||All ALRI||SP||Hib
@@ Line 254: / Line 289: @@
 | Dominica||AmroB||5924||703||51||6||203||120||80||15||1||42||8||0||0||0
 |-
-|colspan=16 |<small>'''ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus'''</small>
+| colspan="16" |<small>'''ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus'''</small>
 |}
 |}
 <div class="mw-customtoggle-table3" style="cursor:pointer; border-radius: 5px 5px 5px 5px; border: solid 2px #4479BA; box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: white; height: 30px; line-height: 30px; width: 200px;padding: 5px 5px;text-align:center; font-size: 120%">'''Europe'''</div>
-{|class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table3"
+{| class="mw-collapsible mw-collapsed"
 |
 {{#widget:BlueTable}}
-{|class="BlueTable" style="font-size:95%"
+{| class="BlueTable" style="font-size:95%"
-!rowspan=2|Country
+! rowspan="2" |Country
-!rowspan=2|WHO Region
+! rowspan="2" |WHO Region
-!rowspan=2|Population 0–4 years
+! rowspan="2" |Population 0–4 years
-!colspan=5|New episodes (incidence)
+! colspan="5" |New episodes (incidence)
-!colspan=5|New severe episodes (severe morbidity)
+! colspan="5" |New severe episodes (severe morbidity)
-!colspan=3|Deaths (mortality)
+! colspan="3" |Deaths (mortality)
 |-
 ! |All ALRI||SP||Hib||RSV||FLU||All ALRI||SP||Hib||RSV||FLU||All ALRI||SP||Hib
@@ Line 374: / Line 409: @@
 | Ukraine||EuroC||2376293||139669||9980||3376||75756||44387||37167||6966||1307||22460||4568||629||207||87
 |-
-|colspan=16 |<small>'''ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus'''</small>
+| colspan="16" |<small>'''ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus'''</small>
 |}
 |}
 <div class="mw-customtoggle-table4" style="cursor:pointer; border-radius: 5px 5px 5px 5px; border: solid 2px #4479BA; box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: white; height: 30px; line-height: 30px; width: 200px;padding: 5px 5px;text-align:center; font-size: 120%">'''South-East Asia Region'''</div>
-{|class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table4"
+{| class="mw-collapsible mw-collapsed"
 |
 {{#widget:BlueTable}}
-{|class="BlueTable" style="font-size:95%"
+{| class="BlueTable" style="font-size:95%"
-!rowspan=2|Country
+! rowspan="2" |Country
-!rowspan=2|WHO Region
+! rowspan="2" |WHO Region
-!rowspan=2|Population 0–4 years
+! rowspan="2" |Population 0–4 years
-!colspan=5|New episodes (incidence)
+! colspan="5" |New episodes (incidence)
-!colspan=5|New severe episodes (severe morbidity)
+! colspan="5" |New severe episodes (severe morbidity)
-!colspan=3|Deaths (mortality)
+! colspan="3" |Deaths (mortality)
 |-
 ! |All ALRI||SP||Hib||RSV||FLU||All ALRI||SP||Hib||RSV||FLU||All ALRI||SP||Hib
@@ Line 414: / Line 449: @@
 | Nepal||SearoD||3506023||832451||58272||33298||240079||142099||95732||17519||5552||21061||4787||5501||1813||1170
 |-
-|colspan=16 |<small>'''ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus'''</small>
+| colspan="16" |<small>'''ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus'''</small>
 |}
 |}
   <div class="mw-customtoggle-table5" style="cursor:pointer; border-radius: 5px 5px 5px 5px; border: solid 2px #4479BA; box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: white; height: 30px; line-height: 30px; width: 200px;padding: 5px 5px;text-align:center; font-size: 120%">'''Western Pacific Region'''</div>
-{|class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table5"
+{| class="mw-collapsible mw-collapsed"
 |
 {{#widget:BlueTable}}
-{|class="BlueTable" style="font-size:95%"
+{| class="BlueTable" style="font-size:95%"
-!rowspan=2|Country
+! rowspan="2" |Country
-!rowspan=2|WHO Region
+! rowspan="2" |WHO Region
-!rowspan=2|Population 0–4 years
+! rowspan="2" |Population 0–4 years
-!colspan=5|New episodes (incidence)
+! colspan="5" |New episodes (incidence)
-!colspan=5|New severe episodes (severe morbidity)
+! colspan="5" |New severe episodes (severe morbidity)
-!colspan=3|Deaths (mortality)
+! colspan="3" |Deaths (mortality)
 |-
 ! |All ALRI||SP||Hib||RSV||FLU||All ALRI||SP||Hib||RSV||FLU||All ALRI||SP||Hib
@@ Line 486: / Line 521: @@
 | Vietnam||WproB||7185862||1728193||124101||35174||498411||295003||197920||37310||5865||57086||34660||3553||1171||420
 |-
-|colspan=16 |<small>'''ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus'''</small>
+| colspan="16" |<small>'''ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus'''</small>
 |}
 |}
 <div class="mw-customtoggle-table6" style="cursor:pointer; border-radius: 5px 5px 5px 5px; border: solid 2px #4479BA; box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: white; height: 30px; line-height: 30px; width: 200px;padding: 5px 5px;text-align:center; font-size: 120%">'''Eastern Mediterranean'''</div>
-{|class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table6"
+{| class="mw-collapsible mw-collapsed"
 |
 {{#widget:BlueTable}}
-{|class="BlueTable" style="font-size:95%"
+{| class="BlueTable" style="font-size:95%"
-!rowspan=2|Country
+! rowspan="2" |Country
-!rowspan=2|WHO Region
+! rowspan="2" |WHO Region
-!rowspan=2|Population 0–4 years
+! rowspan="2" |Population 0–4 years
-!colspan=5|New episodes (incidence)
+! colspan="5" |New episodes (incidence)
-!colspan=5|New severe episodes (severe morbidity)
+! colspan="5" |New severe episodes (severe morbidity)
-!colspan=3|Deaths (mortality)
+! colspan="3" |Deaths (mortality)
 |-
 ! |All ALRI||SP||Hib||RSV||FLU||All ALRI||SP||Hib||RSV||FLU||All ALRI||SP||Hib
@@ Line 548: / Line 583: @@
 | Yemen||EmroD||4057096||1150463||83436||14494||331793||196384||131540||25084||2417||24673||10966||15193||5008||1152
 |-
-|colspan=16 |<small>'''ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus'''</small>
+| colspan="16" |<small>'''ALRI – acute lower respiratory infection, SP – Streptococcus pneumoniae, Hib – Haemophilus influenzae type B, RSV – respiratory syncytial virus, FLU – influenza virus'''</small>
 |}
 |}
-==Guidelines for the Management of Adults with Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia (DO NOT EDIT) <ref name="pmid15699079">{{cite journal |author= |title=Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=171 |issue=4 |pages=388–416 |year=2005 |month=February |pmid=15699079 |doi=10.1164/rccm.200405-644ST |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=15699079 |accessdate=2012-09-13}}</ref>==
+==Hospital Acquired Pneumonia==
+*Pneumonia has accounted for approximately 20% of all hospital-associated infections and 27% and 24% of all infections acquired in the medical intensive-care unit (ICU) and coronary care unit, respectively. <ref name="MagillEdwards2014">{{cite journal|last1=Magill|first1=Shelley S.|last2=Edwards|first2=Jonathan R.|last3=Bamberg|first3=Wendy|last4=Beldavs|first4=Zintars G.|last5=Dumyati|first5=Ghinwa|last6=Kainer|first6=Marion A.|last7=Lynfield|first7=Ruth|last8=Maloney|first8=Meghan|last9=McAllister-Hollod|first9=Laura|last10=Nadle|first10=Joelle|last11=Ray|first11=Susan M.|last12=Thompson|first12=Deborah L.|last13=Wilson|first13=Lucy E.|last14=Fridkin|first14=Scott K.|title=Multistate Point-Prevalence Survey of Health Care–Associated Infections|journal=New England Journal of Medicine|volume=370|issue=13|year=2014|pages=1198–1208|issn=0028-4793|doi=10.1056/NEJMoa1306801}}</ref>
-{{cquote|
+===Incidence===
+*The incidence of HAP is 5-15 cases per 1 000 hospital admissions. <ref>{{cite journal|title=Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia|journal=American Journal of Respiratory and Critical Care Medicine|volume=171|issue=4|year=2005|pages=388–416|issn=1073-449X|doi=10.1164/rccm.200405-644ST}}</ref>
+*The incidence of VAP is 6 to 20 times more than in patients without mechanical support.
-* Many patients with [[HAP]], [[VAP]], and [[HCAP]] are at increased risk for colonization and infection with [[MDR]] pathogens (Level II)
+{| style="border: 0px; font-size: 85%; margin: 3px; width:380px; float:right" align="center"
+| valign="top" |
+|+
+! style="background: #4479BA; color:#FFF;  width: 200px;" | Age
+! style="background: #4479BA; color:#FFF;  width: 200px;" | Females
+! style="background: #4479BA; color:#FFF;  width: 200px;" | Males
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | 18-44 years
+| style="padding: 5px 5px; background: #F5F5F5;" | 5%
+| style="padding: 5px 5px; background: #F5F5F5;" | 4%
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | 45-64 years
+| style="padding: 5px 5px; background: #F5F5F5;" | 14%
+| style="padding: 5px 5px; background: #F5F5F5;" | 13%
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | ≥ 65 years
+| style="padding: 5px 5px; background: #F5F5F5;" | 34%
+| style="padding: 5px 5px; background: #F5F5F5;" | 30%
+|-
+| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Total
+| style="padding: 5px 5px; background: #F5F5F5;" | 53%
+| style="padding: 5px 5px; background: #F5F5F5;" | 47%
+|-
+| colspan="3" style="padding: 5px 5px; background: #F5F5F5;" | <small>Table adapted from 2009–2011 National Medicare Patient Safety Monitoring System <ref name="EckenrodeBakullari2014">{{cite journal|last1=Eckenrode|first1=Sheila|last2=Bakullari|first2=Anila|last3=Metersky|first3=Mark L.|last4=Wang|first4=Yun|last5=Pandolfi|first5=Michelle M.|last6=Galusha|first6=Deron|last7=Jaser|first7=Lisa|last8=Eldridge|first8=Noel|title=The Association between Age, Sex, and Hospital-Acquired Infection Rates: Results from the 2009–2011 National Medicare Patient Safety Monitoring System|journal=Infection Control and Hospital Epidemiology|volume=35|issue=S3|year=2014|pages=S3–S9|issn=0899823X|doi=10.1086/677831}}</ref></small>
+|}
-* It is often difficult to define the exact incidence of HAP and VAP, because there may be an overlap with other lower respiratory      tract infections, such as [[tracheobronchitis]], especially in mechanically ventilated patients (Level III).
+===Mortality===
+*HAP and VAP are nosocomial infections with a high mortality in contrast with other nosocomial infections.
+*This higher mortality rate is associated with MDR pathogens.
-* The exact incidence of HAP is usually between 5 and 15 cases per 1,000 hospital admissions depending on the case definition           and study population; the exact incidence of VAP is 6- to 20-fold greater than in nonventilated patients (Level II).
+===Age===
+*HAP is more commonly reported in patients > 65 years, probably due to the fact that this age population is more commonly hospitalized.
-* HAP and VAP are a frequent cause of nosocomial infection that is associated with a higher crude mortality than other hospital-acquired  infections (Level II).
+===Gender===
+*There is no predominance in gender, although some data reports a higher incidence among females.
-* Patients with late-onset HAP and VAP are more likely to be infected with MDR pathogens and have higher crude mortality than           patients with early-onset disease; patients with early-onset HAP who have recently received antibiotics or had an admission             to a healthcare facility are at risk for colonization and infection with MDR pathogens (Level II).
+=== Ventilator-associated Pneumonia ===
+*VAP occurs in up to 25% of all people who require mechanical ventilation.
-* An increase in crude and attributable mortality for HAP and VAP is associated with the presence of MDR pathogens (Level II).
+*VAP can develop at any time during ventilation, but occurs more often in the first few days after intubation.
+*This is because the intubation process itself contributes to the development of VAP.
-* Bacteria cause most cases of HAP, VAP, and HCAP and many infections are polymicrobial; rates are especially high in patients           with [[ARDS]] (Level I).
+*VAP occurring early after intubation typically involves fewer resistant organisms and is thus associated with a more favorable outcome.
+*Because respiratory failure requiring mechanical ventilation is itself associated with a high mortality, determination of the exact contribution of VAP to mortality has been difficult.
-* HAP, VAP, and HCAP are commonly caused by aerobic gram-negative bacilli, such as P. aeruginosa, K. pneumoniae, and Acinetobacter species, or by gram-positive cocci, such as S. aureus, much of which is MRSA; anaerobes are an uncommon cause of VAP (Level II).
+*As of [[2006]], estimates range from 33% to 50% death in patients who develop VAP.
+*Mortality is more likely when VAP is associated with certain microorganisms (''Pseudomonas'', ''Acinetobacter''), [[Bacteremia|blood stream infections]], and ineffective initial antibiotics.
-* Rates of L. pneumophila vary considerably between hospitals and disease occurs more commonly with serogroup 1 when the water supply is colonized or there is ongoing construction (Level II).
+*VAP is especially common in people who have [[acute respiratory distress syndrome]] (ARDS).
-* Nosocomial virus and fungal infections are uncommon causes of HAP and VAP in immunocompetent patients. Outbreaks of [[influenza]]    have occurred sporadically and risk of infection can be substantially reduced with widespread effective infection control,             vaccination, and use of antiinfluenza agents (Level I).
-* The prevalence of MDR pathogens varies by patient population, hospital, and type of ICU, which underscores the need for local         surveillance data (Level II).
-* MDR pathogens are more commonly isolated from patients with severe, chronic underlying disease, those with risk factors for            HCAP, and patients with late-onset HAP or VAP (Level II)
-}}
-'''For Level of evidence and classes click [[ACC AHA Guidelines Classification Scheme|here]].'''
 ==References==
 {{reflist|2}}
+{{WH}}
+{{WS}}
 [[Category:Pneumonia]]
 [[Category:Pulmonology]]
-[[Category:Infectious disease]]
 [[Category:Emergency medicine]]
 [[Category:Pediatrics]]
 [[Category:Disease]]
-[[Category:primary care]]
-{{WH}}
-{{WS}}

Pneumonia epidemiology and demographics: Difference between revisions

Latest revision as of 23:45, 29 July 2020

Overview

Epidemiology and Demographics

United States of America

International

Age

Seasonal

Gender

Race

Mortality

Special Considerations

Community Acquired Pneumonia

Mortality

Age

Gender

Incidence of Community–Acquired Pneumonia in 2010 in Children 0–4 Years of Age in 192 Countries[12]

Hospital Acquired Pneumonia

Incidence

Mortality

Age

Gender

Ventilator-associated Pneumonia

References

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Incidence of Community–Acquired Pneumonia in 2010 in Children 0–4 Years of Age in 192 Countries^[12]