Enhanced Pneumonia Surveillance

Purpose

The Enhanced Pneumonia Surveillance (EPS) project is a population-based project that is established to gather demographic and epidemiologic data on hospitalized patients admitted with pneumonia at two hospitals located in New Haven County, Connecticut.

Goals & Objectives

• Characterize the demographic and epidemiologic characteristics of pneumonia admissions
• Better understand the burden of hospital admissions due to pneumonia
• Calculate rates of pneumonia admissions on a statewide basis
  

Activities

To gather the data necessary to characterize the demographic and epidemiologic characteristics of all admissions on a statewide-basis would require staffing levels beyond the scope of available funding. Therefore, we propose to conduct enhanced surveillance for pneumonia among all ages in a smaller group of patients at two hospitals in New Haven County. These hospitals were chosen because a clearly defined population denominator could be established for these hospitals. Using 2003 hospital discharge data for New Haven County, a 7-town catchment area was established (pop. 295,750; 2000 census) in which >90% of all persons hospitalized for pneumonia from these towns were hospitalized at either hospital. Active surveillance is conducted on admission logs received from infection control and hospital information system personnel at the surveillance hospitals to identify potential cases. To validate the use of admission logs for case finding purposes, hospital discharge data are used. Patients admitted with pneumonia and are a resident of one of the 7-towns in the catchment area will have their medical chart reviewed and a standardized case report form will be completed on all cases that meet the inclusion criteria. Information collected on patients meeting the inclusion criteria includes: demographics, severity of the disease, and diagnostic laboratory testing that may have been performed to determine an etiology. Between March 1, 2004 through April 31, 2005, 36,857 patients were admitted to these hospitals from the 7-town catchment area. Of these 1,826 (5%) met the study’s inclusion criteria and were classified as patients hospitalized due to severe pneumonia. The highest rates were observed in the fall and winter months, and among those =65 years of age. Similar rates were observed among males (5.9 per 1,000 population) and females (6.4 per 1,000 population), and among Whites (6.6 per 1,000 population) and Blacks (6.4 per 1,000 population). Hispanics (4.7 per 1,000 population) and Asians (2.6 per 1,000 population) had lower rates of hospitalized pneumonia. Risk of hospital admission for pneumonia among non-ECF residents varied by season while risk for ECF residents was similar regardless of season. ECF residents and those = 65 years of age were significantly more likely to die of their hospitalized pneumonia than non-ECF residents (p-value < 0.001). A potential pathogen was identified in only 28% of hospitalized pneumonia cases. Bacterial organisms were more commonly identified among older (= 65 years) hospitalized pneumonia cases while viruses were more common among younger cases. Continued surveillance is warranted to document trends over time. Efforts to improve pathogen detection among hospitalized pneumonia cases are needed to better understand hospitalized pneumonia epidemiology.

Related Links

Hospital-Centered, Population-Based Surveillance for Pneumonia in New Haven, Connecticut April 2004-March 2005