Increased incidence of adult pneumococcal pneumonia during school holiday periods

Priya Daniel*, Chamira Rodrigo, Thomas Bewick, Carmen Sheppard, Sonia Greenwood, Tricia M. McKeever, Mary Slack, Wei Shen Lim

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Child contact is a recognised risk factor for adult pneumococcal disease. Peaks in invasive pneumococcal disease incidence observed during winter holidays may be related to changes in social dynamics. This analysis was conducted to examine adult pneumococcal community-acquired pneumonia (CAP) incidence during school holiday periods. Between September 2008 and 2013, consecutive adults admitted to hospitals covering the Greater Nottingham area with a diagnosis of CAP were studied. Pneumococcal pneumonia was detected using culture and antigen detection methods. Of 2221 adults studied, 575 (25.9%) were admitted during school holidays and 643 (29.0%) had pneumococcal CAP. CAP of pneumococcal aetiology was significantly more likely in adults admitted during school holidays compared to term time (35.3% versus 26.7%; adjusted OR 1.38, 95% CI 1.11-1.72, p=0.004). Over the 5-year period, the age-adjusted incidence of hospitalised pneumococcal CAP was higher during school holidays compared to term time (incident rate ratio 1.35, 95% CI 1.14-1.60, p<0.001); there was no difference in rates of all-cause CAP or non-pneumococcal CAP. Reported child contact was higher in individuals with pneumococcal CAP admitted during school holidays compared to term time (42.0% versus 33.7%, OR 1.43, 95% CI 1.00-2.03, p=0.046). Further study of transmission dynamics in relation to these findings and to identify appropriate intervention strategies is warranted.

Original languageEnglish
Article number00100-2016
JournalERJ Open Research
Issue number1
Publication statusPublished - 1 Jan 2017

Bibliographical note

Funding Information:
The authors would like to thank Tim Harrison from RVPBRU, Colindale, for his support; Sally-Ann Nguyen, Christine More and Seyi Eletu from RVPBRU, Colindale, and Robert Cave, Andrew Shelton, Adrian Patrick, Michelle Stannard and Joanne Palfreyman from the Microbiology Department, Nottingham University Hospitals, for processing the urine samples; clinicians and staff of Nottingham University Hospitals NHS Trust; and Gemma Thompson, Emily Jarvis, Melanie Caine and Gaynor Bates for assisting with patient recruitment. The authors acknowledge the support of Alere in providing BinaxNOW test kits towards the conduct of this study.

Funding Information:
Support statement: This research was derived from an unrestricted investigator-initiated research grant from Wyeth (previously) and Pfizer. Funding information for this article has been deposited with the Crossref Funder Registry.

Publisher Copyright:
© ERS 2017.


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