{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:52:33Z","timestamp":1792788753419,"version":"4.5.0"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Universidad Tecnologica del Peru","award":["P-2025-LIM-26"],"award-info":[{"award-number":["P-2025-LIM-26"]}],"id":[{"id":"https:\/\/ror.org\/0406pmf58","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Universidad Nacional de Asunci\u00f3n","award":["PRONII - PROCIENCIA - CONACYT \u2013 FEEI"],"award-info":[{"award-number":["PRONII - PROCIENCIA - CONACYT \u2013 FEEI"]}],"id":[{"id":"https:\/\/ror.org\/03f27y887","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pneumonia is a leading cause of morbidity and mortality in children and older adults. COVID-19 related disruptions in healthcare and surveillance may have altered incidence, hospitalizations, and deaths. We assessed pneumonia incidence, hospitalizations, and mortality rates in children under five and adults older than 60 years in Peru during the COVID-19 pandemic (2020\u201322) versus the pre-pandemic period (2015\u201319).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective population-based time series study using nationwide surveillance system data on reported pneumonia cases, hospitalizations, and deaths in Peru from 2015 to 2022. Age- and region-specific incidence rates (IRs) and incidence rate ratios (IRRs) with 95% confidence intervals were estimated for pneumonia cases, hospitalizations, and deaths by comparing the pandemic period (2020\u201322) with the pooled pre-pandemic period (2015\u201319).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between January 1, 2015, and December 31, 2022, 170,558 pneumonia cases were reported among children younger than 5 years and 163,938 among adults aged &gt;60 years in Peru. During the same period, 56,680 and 68,476 hospitalizations and 1,563 and 16,485 deaths occurred in these age groups, respectively. Compared with the pre-pandemic period (2015\u20132019), pneumonia incidence among children younger than 5 years declined markedly during the pandemic, decreasing by 71% in 2020 (IRR, 0.29; 95% CI, 0.28\u20130.30), 63% in 2021 (IRR, 0.37; 95% CI, 0.36\u20130.38), and 12% in 2022 (IRR, 0.88; 95% CI, 0.87\u20130.90). Hospitalizations and mortality in this group also decreased. In contrast, adults aged &gt;60 years experienced increased hospitalization and mortality rates, particularly in 2021 (hospitalizations: IRR, 2.04; 95% CI, 1.97\u20132.09; mortality: IRR, 4.28; 95% CI, 4.01\u20134.57). Substantial regional heterogeneity was observed across Peru.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>During the COVID-19 pandemic, pneumonia epidemiology in Peru showed contrasting patterns by age, with sustained declines in incidence, hospitalizations, and mortality among children younger than 5 years, but increased hospitalizations and mortality among adults aged &gt;60 years, underscoring the need to strengthen surveillance, access to timely care, and vaccination programs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0351171","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:31:46Z","timestamp":1791307906000},"page":"e0351171","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pneumonia incidence, hospitalizations and mortality before and during the COVID-19 pandemic in Peru: An observational study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0471-6746","authenticated-orcid":true,"given":"Max Carlos","family":"Ram\u00edrez-Soto","sequence":"first","affiliation":[{"name":"Universidad Tecnol\u00f3gica del Peru","place":["Lima, Peru"],"department":["Facultad de Ciencias de la Salud"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Arroyo-Hernandez","sequence":"additional","affiliation":[{"name":"Universidad de Hu\u00e1nuco","place":["Hu\u00e1nuco, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2048-6071","authenticated-orcid":true,"given":"Juan Vicente Bogado","family":"Machuca","sequence":"additional","affiliation":[{"name":"Polytechnic School, National University of Asuncion","place":["San Lorenzo, Paraguay"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego H.","family":"Stalder","sequence":"additional","affiliation":[{"name":"National University of Asuncion","place":["San Lorenzo, Paraguay"],"department":["Faculty of Engineering"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian E.","family":"Schaerer","sequence":"additional","affiliation":[{"name":"Polytechnic School, National University of Asuncion","place":["San Lorenzo, Paraguay"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"issue":"4","key":"pone.0351171.ref001","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/S2213-2600(25)00087-6","article-title":"Pneumonia: A neglected global threat","volume":"13","author":"The Lancet Respiratory Medicine","year":"2025","journal-title":"Lancet Respir Med"},{"key":"pone.0351171.ref002","article-title":"Global burden of lower respiratory 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