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Pneumococcal vaccination has been associated with declines in pneumonia in both vaccinated and unvaccinated persons. In this study, U.S. hospitalizations for pneumonia were assessed before and after the initiation of the 7-valent pneumococcal vaccination program in children. The introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) into the U.S. infant immunization schedule in 2000 resulted in major reductions in the incidence of invasive pneumococcal disease in all age groups. 1 , 2 The marked decline in disease among unvaccinated persons in addition to those who were vaccinated is attributable to the indirect, or “herd,” protection provided by PCV7. By preventing the acquisition and carriage of vaccine serotypes in the nasopharynx of vaccinated children, PCV7 interfered with this key step in the pathogenesis of pneumococcal disease and reduced the transmission of vaccine serotypes. 3 – 6 Pneumococcal pneumonia accounts for 20 to . . .

BackgroundChanges in invasive pneumococcal disease (IPD) incidence were evaluated after 7 years of 7-valent pneumococcal conjugate vaccine (PCV7) use in US children MethodsLaboratory-confirmed IPD cases were identified during 1998–2007 by 8 active population-based surveillance sites. We compared overall, age group-specific, syndrome-specific, and serotype group-specific IPD incidence in 2007 with that in 1998–1999 (before PCV7) and assessed potential serotype coverage of new conjugate vaccine formulations ResultsOverall and PCV7-type IPD incidence declined by 45% (from 24.4 to 13.5 cases per 100,000 population) and 94% (from 15.5 to 1.0 cases per 100,000 population), respectively (P<.01 for all age groups). The incidence of IPD caused by serotype 19A and other non-PCV7 types increased from 0.8 to 2.7 cases per 100,000 population and from 6.1 to 7.9 cases per 100,000 population, respectively (P<.01 for all age groups). The rates of meningitis and invasive pneumonia caused by non-PCV7 types increased for all age groups (P<.05), whereas the rates of primary bacteremia caused by these serotypes did not change. In 2006–2007, PCV7 types caused 2% of IPD cases, and the 6 additional serotypes included in an investigational 13-valent conjugate vaccine caused 63% of IPD cases among children <5 years-old ConclusionsDramatic reductions in IPD after PCV7 introduction in the United States remain evident 7 years later. IPD rates caused by serotype 19A and other non-PCV7 types have increased but remain low relative to decreases in PCV7-type IPD

Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.

In 2000, seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in the USA and resulted in dramatic reductions in invasive pneumococcal disease (IPD) and moderate increases in non-PCV7 type IPD. In 2010, PCV13 replaced PCV7 in the US immunisation schedule. We aimed to assess the effect of use of PCV13 in children on IPD in children and adults in the USA. We used laboratory-based and population-based data on incidence of IPD from the Active Bacterial Core surveillance (part of the Centers for Disease Control and Prevention's Emerging Infections Program) in a time-series model to compare rates of IPD before and after the introduction of PCV13. Cases of IPD between July 1, 2004, and June 30, 2013, were classified as being caused by the PCV13 serotypes against which PCV7 has no effect (PCV13 minus PCV7). In a time-series model, we used an expected outcomes approach to compare the reported incidence of IPD to that which would have been expected if PCV13 had not replaced PCV7. Compared with incidence expected among children younger than 5 years if PCV7 alone had been continued, incidence of IPD overall declined by 64% (95% interval estimate [95% IE] 59–68) and IPD caused by PCV13 minus PCV7 serotypes declined by 93% (91–94), by July, 2012, to June, 2013. Among adults, incidence of IPD overall also declined by 12–32% and IPD caused by PCV13 minus PCV7 type IPD declined by 58–72%, depending on age. We estimated that over 30 000 cases of IPD and 3000 deaths were averted in the first 3 years after the introduction of PCV13. PCV13 reduced IPD across all age groups when used routinely in children in the USA. These findings provide reassurance that, similar to PCV7, PCVs with additional serotypes can also prevent transmission to unvaccinated populations. Centers for Disease Control and Prevention.

Streptococcus pneumoniae continues to cause a variety of common clinical syndromes, despite vaccination programs for both adults and children. The total U.S. burden of pneumococcal disease is unknown. We constructed a decision tree-based model to estimate U.S. healthcare utilization and costs of pneumococcal disease in 2004. Data were obtained from the 2004–2005 National (Hospital) Ambulatory Medical Care Surveys (outpatient visits, antibiotics) and the National Hospital Discharge Survey (hospitalization rates), and CDC surveillance data. Other assumptions regarding the incidence of each syndrome due to pneumococcus, expected health outcomes, and healthcare utilization were derived from literature and expert opinion. Healthcare and time costs used 2007 dollars. We estimate that, in 2004, pneumococcal disease caused 4.0 million illness episodes, 22,000 deaths, 445,000 hospitalizations, 774,000 emergency department visits, 5.0 million outpatient visits, and 4.1 million outpatient antibiotic prescriptions. Direct medical costs totaled $3.5 billion. Pneumonia (866,000 cases) accounted for 22% of all cases and 72% of pneumococcal costs. In contrast, acute otitis media and sinusitis (1.5 million cases each) comprised 75% of cases but only 16% of direct medical costs. Patients ≥65 years old, accounted for most serious cases and the majority of direct medical costs ($1.8 billion in healthcare costs annually). In this age group, pneumonia caused 242,000 hospitalizations, 1.4 million hospital days, 194,000 emergency department visits, 374,000 outpatient visits, and 16,000 deaths. However, if work loss and productivity are considered, the cost of pneumococcal disease among younger working adults (18–<50) nearly equaled those ≥65. Pneumococcal disease remains a substantial cause of morbidity and mortality even in the era of routine pediatric and adult vaccination. Continued efforts are warranted to reduce serious pneumococcal disease, especially adult pneumonia.

Streptococcus pneumoniae is an important cause of bacterial meningitis. Since the introduction of the heptavalent pneumococcal conjugate vaccine PCV7, rates of pneumococcal meningitis have decreased substantially in the United States, from 1.13 cases to 0.79 case per 100,000 persons between 1998–1999 and 2004–2005; rates of disease from serotypes covered by the vaccine decreased the most, and rates from those not covered increased. Since the introduction of the heptavalent pneumococcal conjugate vaccine PCV7, rates of pneumococcal meningitis have decreased substantially in the United States, from 1.13 cases to 0.79 case per 100,000 persons between 1998–1999 and 2004–2005. Streptococcus pneumoniae is the most common cause of bacterial meningitis in the United States and many countries worldwide. 1 – 4 Despite effective antimicrobial therapy, pneumococcal meningitis remains highly lethal and has substantial long-term sequelae. 4 , 5 The pediatric heptavalent pneumococcal conjugate vaccine (PCV7; Prevnar, Wyeth) has had a major effect on the incidence of pneumococcal disease in the United States. 6 PCV7 not only protects immunized children from pneumococcal disease 7 – 11 but also provides protection to nonimmunized children and adults through herd immunity, resulting from reduced transmission of S. pneumoniae from immunized children. 8 , 10 , 12 , 13 Licensed in 2000, PCV7 is recommended by . . .

Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.

BackgroundSerotype 19A invasive pneumococcal disease (IPD) increased annually in the United States after the introduction of the 7-valent conjugate vaccine (PCV7). To understand this increase, we characterized serotype 19A isolates recovered during 2005 MethodsIPD cases during 1998–2005 were identified through population-based surveillance. We performed susceptibility testing and multilocus sequence typing on 528 (95%) of 554 serotype 19A isolates reported in 2005 ResultsThe incidence of IPD due to serotype 19A increased from 0.8 to 2.5 cases per 100,000 population between 1998 and 2005 (P<.05), whereas the overall incidence of IPD decreased from 24.4 to 13.8 cases per 100,000 population (P<.05). Simultaneously, the incidence of IPD due to penicillin-resistant 19A isolates increased from 6.7% to 35% (P<.0001). Of 151 penicillin-resistant 19A isolates, 111 (73.5%) belonged to the rapidly emerging clonal complex 320, which is related to multidrug-resistant Taiwan19F-14. The remaining penicillin-resistant strains were highly related to other clones of PCV7 serotypes or to isolates within major 19A clonal complex 199 (CC199). In 1999, only CC199 and 3 minor clones were apparent among serotype 19A isolates. During 2005, 11 multiple-isolate clonal sets were detected, including capsular switch variants of a serotype 4 clone ConclusionsPCV7 ineffectiveness against serotype 19A, antibiotic resistance, clonal expansion and emergence, and capsular switching have contributed to the genetic diversity of 19A and to its emergence as the predominant invasive pneumococcal serotype in the United States

The mirror neuron network (MNN) has been proposed as a neural substrate of action understanding. Electroencephalography (EEG) mu suppression has commonly been studied as an index of MNN activity during execution and observation of hand and finger movements. However, in order to establish its role in higher order processes, such as recognizing and sharing emotions, more research using social emotional stimuli is needed. The current study aims to contribute to our understanding of the sensitivity of mu suppression to facial expressions. Modulation of the mu and occipital alpha (8-13 Hz) rhythms was calculated in 22 participants while they observed dynamic video stimuli, including emotional (happy and sad) and neutral (mouth opening) facial expressions, and non-biological stimulus (kaleidoscope pattern). Across the four types of stimuli, only the neutral face was associated with a significantly stronger mu suppression than the non-biological stimulus. Occipital alpha suppression was significantly greater in the non-biological stimulus than all the face conditions. Source estimation standardized low resolution electromagnetic tomography (sLORETA) analysis comparing the neural sources of mu/alpha modulation between neutral face and non-biological stimulus showed more suppression in the central regions, including the supplementary motor and somatosensory areas, than the more posterior regions. EEG and source estimation results may indicate that reduced availability of emotional information in the neutral face condition requires more sensorimotor engagement in deciphering emotion-related information than the full-blown happy or sad expressions that are more readily recognized.

Pneumococcal pneumonia is concentrated among the elderly. Using a decision analytic model, we projected the future incidence of pneumococcal pneumonia and associated healthcare utilization and costs accounting for an aging US population. Between 2004 and 2040, as the population increases by 38%, pneumococcal pneumonia hospitalizations will increase by 96% (from 401 000 to 790 000), because population growth is fastest in older age groups experiencing the highest rates of pneumococcal disease. Absent intervention, the total cost of pneumococcal pneumonia will increase by $2.5 billion annually, and the demand for healthcare services for pneumococcal pneumonia, especially inpatient capacity, will double in coming decades.