Vaccine 29 (2011) 412–416 Contents lists available at ScienceDirect Vaccine journal homepage: www.elsevier.com/locate/vaccine The burden of hospitalisations for community-acquired pneumonia (CAP) and pneumococcal pneumonia in adults in Spain (2003–2007) Ruth Gil-Prieto a,* , Laura García-García a , Alejandro Álvaro-Meca a , Cristina Méndez b , Ana García b , Ángel Gil de Miguel a a Department of Preventive Medicine & Public Health & Medical Immunology & Microbiology, Rey Juan Carlos University, Avda. Atenas s/n, 28922 Madrid (Alcorcon), Spain b Medical Department, Pfizer, Madrid, Spain article info Article history: Received 6 July 2010 Received in revised form 13 September 2010 Accepted 10 November 2010 Available online 25 November 2010 Keywords: Hospitalisations Pneumococcal pneumonia CAP abstract All hospital discharges and deaths related to CAP and pneumococcal-pneumonia from adults over 50 from 2003 to 2007 in Spain were obtained. Among the 447,670 Pneumonia-all causes discharges 17% were pneumococcal pneumonia. The annual hospitalisation rate was 6.27 and 1.09 cases per 1000, respectively. 75,932 deaths for Pneumonia-all causes and 9062 for pneumococcal-pneumonia were reported. CAP and pneumococcal pneumonia are major causes of morbidity and mortality in Spain, especially in the elderly. Despite current preventive measures, no significant changes in hospitalisation, mortality and case-fatality rates were found over the study period. Future preventive measures, like vaccination, could overcome these limitations. © 2010 Elsevier Ltd. All rights reserved. 1. Introduction Community-acquired pneumonia (CAP) is a common infection in developed countries, accounting for a large number of hospital- isations and deaths, especially among adults older than 65 years of age [1–3]. Streptococcus pneumoniae, accounts for up to 50% of the cases [4,5] and is the major bacterial cause of adult CAP that requires hospital admission [6]. Currently, two vaccines that offer protection against pneumococcal disease are available in Spain: a 7-valent conjugate vaccine (PCV7) for children (marketed in June 2001) and a 23-valent polysaccharide vaccine (PPV-23) (marketed in July 1999) which is recommended especially for adults older than the age of 65 years (60 years in Madrid and Catalonia) and for spe- cific groups at risk [7]. PCV7 has been available in Spain only in the private market for healthy children and the uptake has increased from 2002 onwards with reported vaccine coverage in 2006 below 50%, assuming complete vaccination schedules [8]. In October 2006, the Autonomous Region of Madrid approved its inclusion in the childhood vaccination calendar, becoming the first region in Spain to include the PCV7 in its official vaccination programme. Despite the recognised importance of CAP in adults, information on the true burden of the disease is not well known, as suggested by the fact that incidence and mortality rates in adult populations * Corresponding author. Tel.: +34 914888625; fax: +34 914888955. E-mail address: ruth.gil@urjc.es (R. Gil-Prieto). have largely varied in different studies [9,10]. Hospital discharge databases are useful for establishing burden, as they provide a complete record of all hospitalisations and, in general, are not sub- jected to the limitations of outpatient surveillance systems, such as under-diagnosis or deficiencies in reporting. Another advantage of these databases is the standardized diagnosis code lists that enable secular trend analysis of incident disease for a given population. The Spanish centralized discharge database, which includes more than 95% of hospitals of the National Health Care System (cov- ering almost all the Spanish population), can give a reasonable approximation to the burden of pneumonia hospitalisation by age. Furthermore, this database has been shown to be a reliable tool for enumerating cases of CAP that required hospitalisation [6,11–13]. This epidemiological retrospective survey aimed to provide population-based estimates of the burden of hospitalisation for all- cause pneumonia and pneumococcal pneumonia in adults over 50 years of age in Spain during a five-year period (2003–2007). 2. Materials and methods This retrospective study used the national surveillance sys- tem for hospital data (Conjunto Mínimo Básico de Datos; CMBD) maintained by the Ministry of Health. This system uses clinical codes from the Spanish version of the 9th International Classifi- cation of Diseases (Modificación Clínica Clasificación Internacional de Enfermedades; CIE-9-MC) and covers an estimated 98% of public hospitals. Compulsory health insurance covers an estimated 99.5% 0264-410X/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2010.11.025