{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T14:44:20Z","timestamp":1764773060143,"version":"3.46.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Current evidence suggests that in young children with community-acquired alveolar pneumonia (CAAP), bacterial-viral coinfections (mostly respiratory syncytial virus [RSV]-pneumococcus coinfections) are more prevalent among hospitalized children than among outpatients and that RSV-pneumococcal coinfections are more frequently associated with non-PCV13 serotypes. Based on this background, we speculated that following pneumococcal conjugate vaccine [PCV] implementation, the decline of hospitalized CAAP episodes would be lower than that of outpatient episodes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This analysis was a part of an ongoing (since 2004) population-based, active surveillance in children &amp;lt; 5 years, including all CAAP visits to the pediatric emergency room in southern Israel. Community-acquired alveolar pneumonia was radiologically confirmed by consensus reading. Episodes were divided into hospitalized and those discharged without hospitalization (outpatients). We used a negative binomial regression model to evaluate PCV7\/PCV13 impact by age and ethnic group using monthly and yearly incidence rates. Analyzed periods were pre-PCV (2004\u20132009), PCV7\/PCV13 transition (2009\u20132011), early-PCV13 (2011\u20132015), and late-PCV13 (2015\u20132019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 11 130 episodes, 3677 and 7633 were outpatients and hospitalized, respectively. Post-PCV incidence dynamics significantly diverged between the 2 study groups. (1) During the PCV7\/PCV13 transition, outpatient rates significantly declined, but not those of hospitalizations. 2) During late-PCV13 period, a significantly greater decline was reached among outpatients (67%; 95% confidence interval [CI] 62%\u201371%) versus hospitalized (47%; 95% CI 41%\u201354%). This difference remained for all age and ethnic groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The marked divergence in PCV impact between hospitalized and outpatient episodes is intriguing, but consistent with previous studies suggesting that hospitalized CAAP was associated with a lower proportion of PCV13 serotypes, in conjunction with viral-bacterial (mostly RSV-pneumococcus) coinfections.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf710","type":"journal-article","created":{"date-parts":[[2025,11,16]],"date-time":"2025-11-16T12:56:46Z","timestamp":1763297806000},"source":"Crossref","is-referenced-by-count":0,"title":["Differential Impact of Pneumococcal Conjugate Vaccines on Hospitalized\n                    <i>Versus<\/i>\n                    Outpatient Community-Acquired Alveolar Pneumonia in Children Younger Than 5 Years Suggests Differences in Pathogenesis"],"prefix":"10.1093","volume":"12","author":[{"given":"Bart A","family":"van der Beek","sequence":"first","affiliation":[{"name":"The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva ,","place":["Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8746-1410","authenticated-orcid":false,"given":"David","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Pediatric Division, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva ,","place":["Israel"]},{"name":"Pediatric Infectious Diseases Unit, Soroka University Medical Center , Beer Sheva ,","place":["Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7372-6262","authenticated-orcid":false,"given":"Guy","family":"Hazan","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonary Unit, Soroka University Medical Center , Beer Sheva ,","place":["Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8888-1046","authenticated-orcid":false,"given":"Ron","family":"Dagan","sequence":"additional","affiliation":[{"name":"The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva ,","place":["Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"2025120309414318200_ofaf710-B1","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1056\/NEJMra011994","article-title":"Community-acquired pneumonia in children","volume":"346","author":"McIntosh","year":"2002","journal-title":"N Engl J 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