Burden of community-acquired pneumonia in adults over 18 y of age.

This study aimed to determine the economic burden and affecting factors in adult community-acquired pneumonia (CAP) patients (≥ 18 years) by retrospectively evaluating the data of 2 centers in Istanbul province, Turkey. Data of outpatients and inpatients with CAP from January 2013 through June 2014 were evaluated. The numbers of laboratory analyses, imaging, hospitalization days, and specialist visits were multiplied by the relevant unit costs and the costs of the relevant items per patient were obtained. Total medication costs were calculated according to the duration of use and dosage. The mean age was 61.56 ± 17.87 y for the inpatients (n = 211; 48.6% female) and 53.78 ± 17.46 y for the outpatients (n = 208; 46.4% male). The total mean cost was €556.09 ± 1,004.77 for the inpatients and €51.16 ± 40.92 for the outpatients. In the inpatients, laboratory, medication, and hospitalization costs and total cost were significantly higher in those ≥ 65 y than in those <65 y. Besides the hospitalization duration, specialist visit, imaging, laboratory, medication, and hospitalization costs and total cost were significantly higher in those hospitalized more than once than in those hospitalized once. While the specialist visit cost was higher in the inpatients with comorbidities, the imaging cost was higher in the outpatients with comorbidities. CAP poses a higher cost in inpatients, elders, and individuals with comorbidities. Costs can be decreased by rational decisions about hospitalization and antibiotic use according to the recommendations of guidelines and authorities. Vaccination may decrease medical burden and contribute to economy by preventing the disease, especially in risk groups.

[The pilgrimage and the burden of pneumococcal disease in adults]. / Hac ve eriskinlerde pnömokok hastaligi yükü.

Pneumococcal disease is responsible for significant morbidity and mortality. All over the world, 1.6 million people die of pneumococcal disease every year; this estimate includes the deaths of 1 million children aged less than 5 years and the deaths of 600.000- 800.000 adults. The burden of pneumococcal disease is high in adults. Increasing age and the presence of comorbidity has a significant affected of the risk of developing the disease. During mass gatherings, such as pilgrimage individuals, is exposed to severe community-acquired pneumococcal infections. Individuals who has Streptococcus pneumoniae in nasopharynx, have the potential to infection and leave exposed to the risk of pneumococcal disease the other Individuals with sneezing, coughing or out of breath, given breath through droplets of these microorganisms. In the present review, the relationship of pneumococcal disease in adults and pilgrimage, vaccination strategies will be considered and then during a visit to Pilgrimate and Umrah pilgrims against the current vaccine recommendations will be summarised.

Barriers to adult immunization and solutions: Personalized approaches.

Immunization is an important component of preventive healthcare services aiming to prevent and eventually eradicate infectious diseases by immunizing people before they become infected. Although immunization is an integral part of children's healthcare, this fact is underrated, even ignored in adults. In Turkey, adult immunization is available only for certain high risk groups such as health care professionals and populations aged > 65 y and under certain conditions including pregnancy, military service, travel-pilgrimage, and employment procedures. The fact that diseases such as pneumococcal pneumonia, influenza, rubeola, varicella, hepatitis A, and tetanus, which could be associated with severe complications in adults, are vaccine-preventable indicates the importance of adult immunization. In addition to the healthcare providers' knowledge about immunization, effective policies of related professional associations and the management of this issue by regulatory authorities, people's awareness in protecting their own health is of utmost importance in achieving the targeted level of adult immunization. This article focuses on the characteristics of the individuals as one of the 3 main cornerstones (individual, healthcare providers, regulatory authorities and supporting organizations) of immunization practices and discusses barriers to adult immunization and recommends solutions.