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Etiology of Pneumonia in a Pediatric Population with High Pneumococcal Vaccine Coverage: A Prospective Study

Berg, Are Stuwitz MD; Inchley, Christopher Stephen MB ChB, PhD; Aase, Audun PhD; Fjaerli, Hans Olav MD, PhD; Bull, Reidun MD; Aaberge, Ingeborg MD, PhD; Leegaard, Truls Michael MD, PhD; Nakstad, Britt MD, PhD

The Pediatric Infectious Disease Journal: March 2016 - Volume 35 - Issue 3 - p e69–e75
doi: 10.1097/INF.0000000000001009
Original Studies

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.

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.

Accepted for publication September 9, 2015.

The study was supported by research grants from Akershus University Hospital and South-Eastern Norway Regional Health Authority and grants from the Grimsgaard Foundation and the Norwegian Organization for Surveillance of Antimicrobial Resistance. The authors have no conflicts of interest or financial relationships relevant to this article to disclose.

Address for correspondence: Are S. Berg, MD, Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Postal Box 1000, 1478 Loerenskog, Norway. E-mail:

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