{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T17:26:53Z","timestamp":1784222813450,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T00:00:00Z","timestamp":1661299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Merck Sharp &amp; Dohme LLC"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Streptococcus pneumoniae infection is responsible for significant morbidity and mortality, particularly in young children and older adults. The aim of this study was to investigate the incidence of hospitalisation and emergency department (ED) visits in relation to episodes of pneumococcal disease (PD) following the introduction of pneumococcal conjugate vaccines (PCVs) into the Liguria region of Italy. Between 2012 and 2018, episodes of all-cause pneumonia (80,152), pneumococcal-specific pneumonia (1254), unspecified pneumonia (66,293), acute otitis media (AOM; 17,040), and invasive PD (IPD; 1788) were identified from in-patient claims, ED and hospital discharge records, and the Liguria Chronic Condition Data Warehouse. In children &lt; 15 years of age, pneumococcal pneumonia-related hospitalisations decreased from 35 to 13 per 100,000 person-years during the study period (p &lt; 0.001); this decrease is potentially related to PCV use in children. All-cause pneumonia hospitalisations remained stable, whereas IPD hospitalisations increased and AOM hospitalisations decreased. In adults, hospitalisations for all-cause pneumonia increased from 5.00 to 7.50 per 1000 person-years (+50%; p &lt; 0.001). Pneumococcal and unspecified pneumonia hospital admissions increased significantly during the study period, considerably affecting those \u2265 65 years of age. IPD hospitalisations varied across all age groups, but a significant change was not observed. Despite pneumococcal vaccination, substantial burden remains for PD in children and adults in Liguria, Italy.<\/jats:p>","DOI":"10.3390\/vaccines10091375","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T02:55:34Z","timestamp":1661309734000},"page":"1375","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Incidence of Hospitalisation and Emergency Department Visits for Pneumococcal Disease in Children, Adolescents, and Adults in Liguria, Italy: A Retrospective Analysis from 2012\u20132018"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4683-1945","authenticated-orcid":false,"given":"Matteo","family":"Astengo","sequence":"first","affiliation":[{"name":"Regional Health Agency of Liguria (ALiSa), Piazza della Vittoria 15, 16121 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Paganino","sequence":"additional","affiliation":[{"name":"Regional Health Agency of Liguria (ALiSa), Piazza della Vittoria 15, 16121 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9707-5214","authenticated-orcid":false,"given":"Daniela","family":"Amicizia","sequence":"additional","affiliation":[{"name":"Regional Health Agency of Liguria (ALiSa), Piazza della Vittoria 15, 16121 Genoa, Italy"},{"name":"Department of Health\u2019s Science (DiSSal), University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Sticchi","sequence":"additional","affiliation":[{"name":"Department of Health\u2019s Science (DiSSal), University of Genoa, 16132 Genoa, Italy"},{"name":"Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2433-9610","authenticated-orcid":false,"given":"Andrea","family":"Orsi","sequence":"additional","affiliation":[{"name":"Department of Health\u2019s Science (DiSSal), University of Genoa, 16132 Genoa, Italy"},{"name":"Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8463-8487","authenticated-orcid":false,"given":"Giancarlo","family":"Icardi","sequence":"additional","affiliation":[{"name":"Department of Health\u2019s Science (DiSSal), University of Genoa, 16132 Genoa, Italy"},{"name":"Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2404-3609","authenticated-orcid":false,"given":"Maria Francesca","family":"Piazza","sequence":"additional","affiliation":[{"name":"Regional Health Agency of Liguria (ALiSa), Piazza della Vittoria 15, 16121 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salini","family":"Mohanty","sequence":"additional","affiliation":[{"name":"Merck & Co., Inc., 126 East Lincoln Ave., P.O. Box 2000, Rahway, NJ 07065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Senese","sequence":"additional","affiliation":[{"name":"MSD Italy, Via Vitorchiano 151, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Marco","family":"Prandi","sequence":"additional","affiliation":[{"name":"MSD Italy, Via Vitorchiano 151, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Ansaldi","sequence":"additional","affiliation":[{"name":"Regional Health Agency of Liguria (ALiSa), Piazza della Vittoria 15, 16121 Genoa, Italy"},{"name":"Department of Health\u2019s Science (DiSSal), University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1128\/CMR.00018-12","article-title":"Pediatric invasive pneumococcal disease in the United States in the era of pneumococcal conjugate vaccines","volume":"25","author":"Tan","year":"2012","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e197","DOI":"10.1016\/j.ijid.2009.05.010","article-title":"Burden of invasive pneumococcal disease and serotype distribution among S. pneumoniae isolates in young children in Europe: Impact of the 7-valent pneumococcal conjugate vaccine and considerations for future conjugate vaccines","volume":"14","author":"Isaacman","year":"2010","journal-title":"Int. J. Infect. Dis."},{"key":"ref_3","unstructured":"Center for Disease Control and Prevention (2020, December 01). Pneumococcal Vaccination: What Everyone Should Know, Available online: https:\/\/www.cdc.gov\/vaccines\/vpd\/pneumo\/public\/index.html."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1007\/s12325-020-01248-7","article-title":"Burden of community-acquired pneumonia and unmet clinical needs","volume":"37","author":"Sarda","year":"2020","journal-title":"Adv. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1093\/jpids\/piaa035","article-title":"Impact of the 13-valent pneumococcal conjugate vaccine on invasive pneumococcal disease after introduction into routine pediatric use","volume":"10","author":"Baxter","year":"2021","journal-title":"J. Pediatric Infect. Dis. Soc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1093\/aje\/kwv283","article-title":"Relating pneumococcal carriage among children to disease rates among adults before and after the introduction of conjugate vaccines","volume":"183","author":"Weinberger","year":"2016","journal-title":"Am. J. Epidemiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1136\/thoraxjnl-2018-211767","article-title":"Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: Implications for adult vaccination","volume":"74","author":"Hanquet","year":"2019","journal-title":"Thorax"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1001\/jamainternmed.2016.8289","article-title":"Developing better pneumococcal vaccines for adults","volume":"177","author":"Weinberger","year":"2017","journal-title":"JAMA Intern. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Orsi, A., Ansaldi, F., Trucchi, C., Rosselli, R., and Icardi, G. (2016). Pneumococcus and the elderly in Italy: A summary of available evidence regarding carriage, clinical burden of lower respiratory tract infections and on-field effectiveness of PCV13 vaccination. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17071140"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"010408","DOI":"10.7189\/jogh.06.010408","article-title":"Cost of management of severe pneumonia in young children: Systematic analysis","volume":"6","author":"Zhang","year":"2016","journal-title":"J. Glob. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1080\/21645515.2017.1371378","article-title":"Economic burden of pneumococcal infections in children under 5 years of age","volume":"14","author":"Ceyhan","year":"2018","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Astengo, M., Paganino, C., Amicizia, D., Trucchi, C., Tassinari, F., Sticchi, C., Sticchi, L., Orsi, A., Icardi, G., and Piazza, M.F. (2021). Economic burden of pneumococcal disease in individuals aged 15 years and older in the Liguria region of Italy. Vaccines, 9.","DOI":"10.3390\/vaccines9121380"},{"key":"ref_13","unstructured":"European Centre for Disease Prevention and Control (2022, March 02). Annual Epidemiological Report for 2018: Invasive Pneumococcal Disease. Available online: https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/AER_for_2018_IPD.pdf."},{"key":"ref_14","unstructured":"Istat (2022, March 01). Demografia in Cifre. Available online: http:\/\/demo.istat.it\/."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3459","DOI":"10.1016\/j.vaccine.2009.01.052","article-title":"Universal childhood immunisation against S. pneumoniae: The five-year experience of Liguria Region, Italy","volume":"27","author":"Durando","year":"2009","journal-title":"Vaccine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"211","DOI":"10.4161\/hv.7.0.14602","article-title":"Epidemiological changes after PCV7 implementation in Italy: Perspective for new vaccines","volume":"7","author":"Ansaldi","year":"2011","journal-title":"Hum. Vaccines"},{"key":"ref_17","unstructured":"Ministero della Salute (2021, September 22). DGPRV 0024720-P-27\/05\/2010. Indicazioni in Merito alla Somministrazione del Vaccino Antipneumococcico Prevenar 13 in et\u00e0 Pediatrica, Available online: https:\/\/www.fimpcalabria.org\/public\/vaccinazioni\/indicazioni%20in%20merito%20alla%20somministrazione%20del%20vaccino%20antipneumococcico%20prevenar%2013%20in%20et%C3%A0%20pediatrica%20(2).pdf."},{"key":"ref_18","unstructured":"Gruppo di Lavoro del CNESPS (2013). Dati e Evidenze Disponibili per L\u2019utilizzo dei Vaccini Anti-Pneumococcici nei Soggetti a Rischio di Qualsiasi et\u00e0 e per L\u2019eventuale Ampliamento Dell\u2019offerta ai Soggetti Anziani, Centro Nazionale di Epidemiologia."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"206757","DOI":"10.1155\/2015\/206757","article-title":"Impact of pneumococcal conjugate universal routine vaccination on pneumococcal disease in Italian children","volume":"2015","author":"Fortunato","year":"2015","journal-title":"J. Immunol. Res."},{"key":"ref_20","unstructured":"Epicentro (2021, September 22). Vaccini e Vaccinazioni. Le Vaccinazioni in Italia. Available online: https:\/\/www.epicentro.iss.it\/vaccini\/dati_Ita#pneumo."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"33","DOI":"10.4161\/hv.26650","article-title":"Towards the 13-valent pneumococcal conjugate universal vaccination: Effectiveness in the transition era between PCV7 and PCV13 in Italy, 2010\u20132013","volume":"10","author":"Martinelli","year":"2014","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S2213-2600(14)70032-3","article-title":"Effect of 13-valent pneumococcal conjugate vaccine on admissions to hospital 2 years after its introduction in the USA: A time series analysis","volume":"2","author":"Simonsen","year":"2014","journal-title":"Lancet Respir. Med."},{"key":"ref_23","unstructured":"Legislative Assembly of Liguria (2015). Aggiornamento Piano Regionale Prevenzione Vaccinale. Boll. Uff. Della Reg. Liguria, 46, 100\u2013113."},{"key":"ref_24","unstructured":"EpiCentro Epidemiology for Public Health (2022, July 15). InfluNet-Epi: Epidemiological Surveillance System for Influenza Syndromes. Available online: https:\/\/www.epicentro.iss.it\/influenza\/flunews#epi."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1080\/21645515.2017.1264796","article-title":"Hospitalizations for pneumonia, invasive diseases and otitis in Tuscany (Italy), 2002\u20132014: Which was the impact of universal pneumococcal pediatric vaccination?","volume":"13","author":"Boccalini","year":"2017","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e187","DOI":"10.1017\/S0950268820001077","article-title":"Impact of vaccination on invasive pneumococcal disease in Italy 2007\u20132017: Surveillance challenges and epidemiological changes","volume":"148","author":"Monali","year":"2020","journal-title":"Epidemiol. Infect."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1097\/INF.0000000000000849","article-title":"Decline in pneumococcal nasopharyngeal carriage of vaccine serotypes after the introduction of the 13-valent pneumococcal conjugate vaccine in children in Atlanta, Georgia","volume":"34","author":"Desai","year":"2015","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/S2213-2600(13)70165-6","article-title":"Immunosenescence and pneumococcal disease: An imbalance in host-pathogen interactions","volume":"2","author":"Krone","year":"2014","journal-title":"Lancet Respir. Med."},{"key":"ref_29","unstructured":"World Health Organization (2022, February 24). Pneumonia. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/pneumonia."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"351","DOI":"10.3947\/ic.2013.45.4.351","article-title":"Diagnosis of pneumococcal pneumonia: Current pitfalls and the way forward","volume":"45","author":"Song","year":"2013","journal-title":"Infect. Chemother."},{"key":"ref_31","unstructured":"(2022, August 23). GPP3 Guidelines. Available online: https:\/\/www.ismpp.org\/gpp3."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/10\/9\/1375\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:14:19Z","timestamp":1760141659000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/10\/9\/1375"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,24]]},"references-count":31,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["vaccines10091375"],"URL":"https:\/\/doi.org\/10.3390\/vaccines10091375","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,24]]}}}