Pneumonia epidemiology and demographics

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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

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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

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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

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* 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

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* 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

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* 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

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

### Gender

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* CAP occurs more commonly in males than females

### Race

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* More common in African Americans than caucasians.

### Mortality

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

### Special Considerations

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* 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

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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

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* 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

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* 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

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* 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]

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▸ 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)

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|
|
|
|

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)

|
|
|
|
|

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)

|
|
|
|
|

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)

|
|
|
|
|

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)

|
|
|
|
|

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)

|
|
|
|
|

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

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* 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

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* 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

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* 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

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

### Gender

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

### Ventilator-associated Pneumonia

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* 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

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1. ↑ "Pneumococcal Disease - Epidemiology and Prevention of Vaccine-Preventable Diseases".
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.CS1 maint: Multiple names: authors list (link) CS1 maint: PMC format (link)
3. ↑ http://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".
6. ↑ 6.0 6.1 6.2 6.3 "CDC Pneumonia FastStats".
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)
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)
9. ↑ "WHO". Text " The top 10 causes of death " ignored (help)
10. ↑ http://www.cdc.gov/nchs/data/series/sr_13/sr13_168.pdf
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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link) CS1 maint: PMC format (link)
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.
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.

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