Pneumococcal disease has a high burden in adults in the United Kingdom (UK); however, the total burden is underestimated, principally because most cases of community-acquired pneumonia (CAP) are non-invasive. Research into pneumonia receives poor funding relative to its disease burden (global mortality, disability-adjusted life years, and years lived with disability), ranking just 20 out of 25 for investment in infectious diseases in the UK. The current accuracy of data for establishing incidence rates is questionable, and it is a reflection of the paucity of research that much of the background information available derives from nearly 30 years ago. Given the relationship between CAP and mortality (pneumonia accounts for 29,000 deaths per annum in the UK, and 5-15% of patients hospitalised with CAP die within 30 days of admission), and the increasing threat of antimicrobial resistance associated with inappropriate antibiotic prescribing, such neglect of a highly prevalent problem is concerning. In this Call to Action, we explore the poorly understood burden of CAP in the UK, discuss the importance of an accurate diagnosis and appropriate treatment, and suggest how national collaboration could improve the management of an often life-threatening, yet potentially preventable disease.
Keywords: Antimicrobial resistance; Clostridium Difficile; Community-acquired pneumonia; Immunization; Pneumococcal disease; Pneumonia burden; Pneumonia diagnostics; Pneumonia epidemiology; Streptococcus Pneumoniae.
Conflict of interest statement
Ethics approval and consent to participate
Consent for publication
Dr. James Chalmers has received research grant support from AstraZeneca, Pfizer, GlaxoSmithKline, Boehringer-Ingelheim and Bayer Healthcare and has participated in advisory boards or lectures for Griffols, AstraZeneca, Pfizer, Napp, Boehringer-Ingelheim and Bayer Healthcare.
Prof. Peter Hawkey has received support from Pfizer to present at educational meetings and to attend advisory board meetings, as well as research funding and/or speaker support from: AstraZeneca, Beckton Dickinson, Eumedica; MSD, Novartis, Novacta, Roche, Department of Health UK, NIHR, and PHE. He is also Director of Modus Medica, a medical education/consultancy.
Prof. Mary Slack has received personal fees from GSK, Pfizer, AstraZeneca and Sanofi Pasteur as a speaker at international meetings and as a member of advisory boards (outside the scope of the submitted work). She has also worked as a contractor for Pfizer.
James Campling, Gillian Ellsbury and Harish Madhava are full-time employees of Pfizer; no other conflicts of interest to declare.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Burden of community-acquired pneumonia in North American adults.Postgrad Med. 2010 Mar;122(2):130-41. doi: 10.3810/pgm.2010.03.2130. Postgrad Med. 2010. PMID: 20203464 Review.
Serotype prevalence in adults hospitalised with pneumococcal non-invasive community-acquired pneumonia.Thorax. 2012 Jun;67(6):540-5. doi: 10.1136/thoraxjnl-2011-201092. Epub 2012 Feb 28. Thorax. 2012. PMID: 22374921 Clinical Trial.
Severity scoring in community-acquired pneumonia caused by Streptococcus pneumoniae: a 5-year experience.Int J Antimicrob Agents. 2004 Nov;24(5):485-90. doi: 10.1016/j.ijantimicag.2004.05.006. Int J Antimicrob Agents. 2004. PMID: 15519482
Research investments for UK infectious disease research 1997-2013: A systematic analysis of awards to UK institutions alongside national burden of disease.J Infect. 2018 Jan;76(1):11-19. doi: 10.1016/j.jinf.2017.10.006. Epub 2017 Oct 20. J Infect. 2018. PMID: 29061335
Evolving trends in Streptococcus pneumoniae resistance: implications for therapy of community-acquired bacterial pneumonia.Int J Antimicrob Agents. 2010 Sep;36(3):197-204. doi: 10.1016/j.ijantimicag.2010.04.013. Epub 2010 Jun 16. Int J Antimicrob Agents. 2010. PMID: 20558045 Review.
Cited by 6 articles
Defining Community-Acquired Pneumonia as a Public Health Threat: Arguments in Favor from Spanish Investigators.Med Sci (Basel). 2020 Jan 25;8(1):6. doi: 10.3390/medsci8010006. Med Sci (Basel). 2020. PMID: 31991843 Free PMC article.
The impact of certain underlying comorbidities on the risk of developing hospitalised pneumonia in England.Pneumonia (Nathan). 2019 Oct 11;11:4. doi: 10.1186/s41479-019-0063-z. eCollection 2019. Pneumonia (Nathan). 2019. PMID: 31632897 Free PMC article.
Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia.J Clin Med. 2019 Jul 2;8(7):961. doi: 10.3390/jcm8070961. J Clin Med. 2019. PMID: 31269766 Free PMC article.
Interventions to Increase the Rate of Influenza and Pneumococcal Vaccination in Patients with Chronic Obstructive Pulmonary Disease: A Scoping Review.Medicina (Kaunas). 2019 Jun 15;55(6):277. doi: 10.3390/medicina55060277. Medicina (Kaunas). 2019. PMID: 31208087 Free PMC article. Review.
Estimating severity of influenza epidemics from severe acute respiratory infections (SARI) in intensive care units.Crit Care. 2018 Dec 19;22(1):351. doi: 10.1186/s13054-018-2274-8. Crit Care. 2018. PMID: 30567568 Free PMC article.
- Waight WA, Andrews NJ, Ladhani SN, Sheppard CL, Slack MPE, Miller E. Effect of the 13-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in England and Wales 4 years after its introduction: an observational cohort study. Lancet Infect Dis. 2015;15:535–543. doi: 10.1016/S1473-3099(15)70044-7. - DOI - PubMed
- British Lung Foundation. The battle for breath – the impact of lung disease in the UK. 2016. Available from: https://www.blf.org.uk/what-we-do/our-research/the-battle-for-breath-2016. Accessed Apr 2017.
- Bruns AH, Oosterheert JJ, Cucciolillo MC, El Moussaoui R, Groenwold RH, Prins JM, et al. Cause-specific long-term mortality rates in patients recovered from community-acquired pneumonia as compared with the general Dutch population. Clin Microbiol Infect. 2011;17:763–768. doi: 10.1111/j.1469-0691.2010.03296.x. - DOI - PubMed
- Townsend N, Wilson L, Bhatnagar P, Wickramasinghe W, Rayner M, Nichols M. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J. 2016;0:1–14.