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Our objective was to evaluate the impact of body composition (BC), beyond body mass index (BMI), and lipid metabolism disorders on therapeutic responses and outcomes in high-grade serous ovarian cancer (HGSOC).Methods: 123 and 415 patients with advanced HGSOC from two cohorts (PUC and TCGA) were analyzed. Databases containing clinical/genomic variables were built-up. BC was estimated using the measurement of adiposity (e.g., Whole body Adipose Tissue [WBAT]) and muscle mass (Lumbar muscle area to vertebral body at L4-level, [PLVI]) by CT-scan. A list of 425 genes linked to obesity and lipid metabolism was used to identify clusters using non-negative matrix factorization. GSEA, Gene Ontology, KEGG pathways enrichment, and Ecotyper analyzes were also made. Survival curves and Cox-regression models were also built-up. Results: We identified four BC types and two clusters that, unlike BMI, effectively correlate with survival regardless of achieving optimal debulking or complete response. Mention deserves central sarcopenia, which was associated with worse survival in any condition. So also, that recovering a normal BC and adding medications to correct metabolism disorders (e.g., statins) could have a positive impact on outcomes. Along with this, we showed that micro-environments depleted of immune cells predominate in HGSOC, something more evident in the BC type (High WBAT/Low PLVI) and cluster (Obesity/Lipid Metabolism Type I) with worse prognosis. Conclusions: Here, we demonstrate the relevance of BC and lipid metabolism disorders in determining therapeutic responses and long-term outcomes. Also, the importance of incorporating corrective measures addressing these disorders to obtain better results. (Research supported by Fondecyt 1201083) Citation Format: Mauricio A. Cuello-Fredes, Fernan Gomez, Ignacio Wichmann, Felipe Suarez, Sumie Kato, Jorge Brañes, Elisa Orlandini, Carolina Ibañez. Body composition and metabolic dysfunction really matter for the achievement of better outcomes in high-grade serous ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 922.

Although obesity-associated metabolic disorders have a negative impact on various cancers, such evidence remains controversial for ovarian cancer. Here, we aimed to evaluate the impact of body composition (BC) and metabolism disorders on outcomes in high-grade serous ovarian cancer (HGSOC). Methods: We analyzed clinical/genomic data from two cohorts (PUC n = 123/TCGA-OV n = 415). BC was estimated using the measurement of adiposity/muscle mass by a CT scan. A list of 425 genes linked to obesity/lipid metabolism was used to cluster patients using non-negative matrix factorization. Differential expression, gene set enrichment analyses, and Ecotyper were performed. Survival curves and Cox-regression models were also built-up. Results: We identified four BC types and two clusters that, unlike BMI, effectively correlate with survival. High adiposity and sarcopenia were associated with worse outcomes. We also found that recovery of a normal BC and drug interventions to correct metabolism disorders had a positive impact on outcomes. Additionally, we showed that immune-cell-depleted microenvironments predominate in HGSOC, which was more evident among the BC types and the obesity/lipid metabolism cluster with worse prognosis. Conclusions: We have demonstrated the relevance of BC and metabolism disorders as determinants of outcomes in HGSOC. We have shone a spotlight on the relevance of incorporating corrective measures addressing these disorders to obtain better results.

Updated data regarding the epidemiology of imported malaria in Italy are needed. The aim of this study is to evaluate trends in incidence and associated lethality of malaria episodes and to consider if there has been an increase in paediatric cases in the region of Tuscany.All malaria cases diagnosed from 2000 to 2017 in 31 Tuscan hospitals were retrospectively identified. Epidemiological data regarding hospitalization rates and lethality for malaria in paediatric and adult population were described.Among the 1102 retrieved cases of malaria (134 children and 968 adults). Plasmodium falciparum was the most commonly reported species (67%). The overall hospitalization rate was of 1.69 cases per 100,000 population/year. Hospitalization rate in the total population decreased from 2000 to 2009 (p 0.01) and increased from 2009 to 2017 (p 0.01), similar trends were observed in adults and children. However, in 2010-2017, the cumulative child group incidence of 1.78 per 100,000 surpassed that of the adult group of 1.53 per 100,000 (p 0.01). Fifteen deaths occurred, all of them in adults, giving a crude lethality rate of 1.36%.In Tuscany, malaria is still a health concern in terms of both morbidity and mortality. Educational actions and pre-travel advice must be promoted.

Introduction Lymphadenectomy is a common procedure in gynecologic oncology. Nonetheless, it is associated to important number of side effects. During the last decade there have been enormous efforts to develop different SLN techniques to reduce complications without affecting survival. Objective Evaluate the experience of SLN technique in a university setting. Methods Retrospective review of 58 cervical and endometrial cancers evaluated with SLN. Results Forty-one of the patients presented with uterine cervical cancer and 17 endometrial cancer. The method used for detection of the SLN was patent blue dye only in 42 patients (72%), technetium 99 in 2 (3.5%), both techniques was used in 10 (17%) and ICG in 4 (%) cases. 40 (69%) patients had laparoscopy. At least one pelvic SLN was detected in 53 (91.4%) 7 patients. Bilateral detection was achieved in 39 (67.2%). Most of the SLN were identified next to external iliac vessels and the obturator fossa. In 97% of the 92 samples identified as SLN had at least one lymph node detected. The mean of lymph-node count was 1.8 (1–7). Patients with uterine cervical cancer had neither SLN nor non-SLN positive. Four patients with endometrial cancer (23.52%) had metastasis on SLN. There were no false negative SLN on those patients who underwent lymphadenectomy. There were no surgical complications derived from de SLN technique. Conclusion SLN technique in cervical and endometrial cancer is technically feasible. Our results show that a good detection rate can be achieved for a proper diagnostic of lymph node status.

RESUMEN Introducción: La reciente pandemia por SARS-CoV-2 (COVID-19) ha hecho resurgir preocupación sobre la exposición inadvertida del equipo quirúrgico a agentes infecciosos transmisibles por vía aérea durante el acto quirúrgico. El objetivo de este trabajo es describir la confección de un sistema de filtrado simple y de bajo costo que permite reducir el riesgo de exposición al virus, particularmente en el proceso de aspiración, recambio y remoción del neumoperitoneo en cirugía laparoscópica. Materiales y Método: Se diseñó e implementó un circuito cerrado de evacuación y de filtrado del neumoperitoneo en cirugías ginecológicas laparoscópicas en un centro de salud terciario. El circuito incluye un filtro HEPA (High Efficiency Particulate Air) y una trampa de vacío que contiene una solución de inactivación en base a amonio cuaternario o hipoclorito de sodio. Resultados: Desde su implementación se han realizado 17 cirugías laparoscópicas ginecológicas por diversas patologías. Dos de ellas fueron en pacientes Covid-19 (+). A la fecha no se han reportado contagios en el equipo médico que participó en la cirugía. Conclusiones: Es posible implementar un sistema de evacuación del neumoperitoneo en cirugía laparoscópica presumiblemente eficaz en minimizar el riesgo de exposición al virus SARS-COV-2 (Covid-19). Su bajo costo lo hace especialmente recomendable en países en vías de desarrollo.La reciente pandemia por SARS-CoV-2 (COVID-19) ha despertado alarmas sobre la exposición inadvertida del equipo quirúrgico a agentes infecciosos transmisibles por vía aérea y que pueden diseminarse durante el acto quirúrgico. El objetivo de este trabajo es comunicar un circuito de filtrado simple y de bajo costo que permita reducir el riesgo de exposición, particularmente asociado a la génesis de fómites y remoción del neumoperitoneo en cirugía laparoscópica. Materiales y Método: Se diseñó e implementó un circuito seguro de evacuación y de filtrado del neumoperitoneo en cirugías ginecológicas en la red de salud UC-Christus. El circuito incluye un filtro HEPA y una trampa de vacío conteniendo una solución de inactivación en base a amonio cuaternario o hipoclorito de sodio. Resultados: Desde su implementación se han realizado 17 cirugías laparoscópicas ginecológicas por diversas patologías. Dos de ellas fueron en pacientes Covid-19 (+). A la fecha no se han reportado contagios en el equipo médico que participó en la cirugía. Conclusiones: Es posible implementar un sistema de evacuación del neumoperitoneo seguro y de bajo costo como medida de protección adicional en cirugía laparoscópica que minimice el riesgo de contagio para el equipo médico en países en vías de desarrollo.

Objective To evaluate the usefulness of endocervical curettage (ECC) during loop electrosurgical excision procedures (LEEPs) in predicting the risk of persistence/recurrence of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) and informing clinical decision-making after LEEP. Methods The present retrospective study included women undergoing LEEP for CIN2+ at a teaching hospital in Chile between January 1, 2007, and December 31, 2014. Demographic, pathologic, and follow-up data were collected. Associations between predictors and treatment failure (persistent/recurrent disease) were examined; a Cox model was used to assess the effects of different variables on the failure rate. Results The analysis included 330 women with a mean follow-up of 29.4 months; 188 women underwent ECC at the time of LEEP. On multivariate analysis, a positive ECC was the only variable significantly associated with persistence/recurrence (P=0.001). In the Cox model, positive ECC (P=0.001) and positive margins (P=0.009) were independently associated with higher failure rates. When faced with positive ECC findings, clinicians tended to perform additional treatment instead of advising follow-up. Conclusion Positive findings from ECC performed during LEEP were a better predictor of persistent/recurrent disease than margin status, after adjusting the individual variable effect in the Cox modelling. The performance of ECC is recommended during any LEEP performed for CIN2+; in particular, it should never be omitted if endocervical disease is suspected.

SUMMARYTo evaluate measles incidence and its relevant changes over a 14-year period (2000–2014), we analysed data from the regional hospital discharge database on children and adults hospitalized in Tuscany, Italy. A total of 181 paediatric and 413 adult cases were identified. Despite all the efforts towards regional measles elimination, we observed that the overall measles hospitalization rates for children and adults living in Tuscany globally increased from 0·45 to 0·85/100 000 during the study period (P = 0·001) showing fluctuations due to periodic measles outbreaks. Data stratified by age group showed that the hospitalization rate significantly increased in young adults over the study period, confirming an increase in susceptibility to measles in this subpopulation. Conversely, no statistically significant difference was observed in the hospitalization rate in the other age groups. However, children aged

Background Invasive bacterial diseases (IBD) are a serious cause of hospitalization, sequelae and mortality. Albeit a low incidence, an increase in cases due to H. influenzae was registered in the past 4 years and, in the Tuscany region, an excess of cases due to N. meningitidis since 2015 is alarming. The purpose of this study is to deepen the knowledge of IBD epidemiology in Tuscany with particular attention to temporal trends. Methods Tuscan residents hospitalized for IBD from January 1st 2000 to March 18th 2016 were selected from the regional hospital discharge database based on ICD-9-CM codes. Age-specific and standardized hospitalization rates were calculated together with case-fatality rates (CFRs). A time-trend analysis was performed; whereas, prognostic factors of death were investigated through univariable and multivariable analyses. Results The average standardized hospitalization rates for invasive meningococcal diseases (IMD), invasive pneumococcal diseases and invasive diseases due to H. influenzae from 2000 to 2016 were 0.6, 1.8, and 0.2 per 100,000, respectively. The average CFRs were 10.5%, 14.5% and 11.5% respectively with higher values in the elderly. Older age was significantly associated with higher risk of death from all IBD. A significant reduction in hospitalization rates for IMD was observed after meningococcal C conjugate vaccine introduction. The Annual Percentage Change (APC) was -13.5 (95% confidence interval (CI) -22.3; -3.5) in 2005–2013 but has risen since that period. Furthermore, a significant increasing trend of invasive diseases due to H. influenzae was observed from 2005 onwards in children 1–4 years old (APC 13.3; 95% CI 0; 28.3). Conclusions This study confirms changes in the epidemiology of invasive diseases due to H. influenzae and IMD. Furthermore, attention is called to the prevention of IBD in the elderly because of the age group’s significantly higher rate of hospitalizations and deaths for all types of IBD. Electronic supplementary material The online version of this article (10.1186/s12879-018-3316-1) contains supplementary material, which is available to authorized users.

Aim To provide epidemiological data on pertussis in a highly vaccinated paediatric population, focusing on the age of the infected children. Methods We analysed data from the regional hospital discharge database on children hospitalised for pertussis in Tuscany, Italy, from January 2000 to December 2012. Results A total of 279 cases were recorded. The majority of hospitalised children were infants (75.6%), who had the highest rate of complications (24.2%) of any age group and a crude mortality rate of 9.47 per 1000. The overall hospitalisation rate decreased significantly during the study period, from 4.23 to 2.82 per 100 000, but when we analysed the data by age groups, we found notable differences. Hospitalisation rates in the 1- to 4-year-old age group decreased significantly from 2.82 in the year 2000 to zero per 100 000 in 2012 and decreased significantly in the 5- to 9-year-old age group over the same period, from 6.58 to 0.63 per 100 000. Overall hospitalisation rates in the infant group remained high at 53.14 per 100 000, with three peaks due to periodic pertussis outbreaks. Conclusion Pertussis is still a relevant health concern in infants who are unvaccinated or incompletely immunised, both in terms of morbidity and mortality.

Objetivo : Evaluar el rendimiento de la angiografia pulmonar y la venografia por tomografia computada (TC) empleando un tomografo multidetector de 64 canales en el diagnostico de la enfermedad tromboembolica. Material y metodo : Estudio prospectivo de pacientes sometidos a angiografia pulmonar por TC (angioTC) y venografia por TC (venoTC) por sospecha clinica de enfermedad tromboembolica (ETE). Se registro la presencia y localizacion radiologica del tromboembolismo pulmonar (TEP) y de la trombosis venosa profunda (TVP) aislada o concomitante, ademas de hallazgos tomograficos con posible significacion clinica. Resultados : Se realizo angioTC y venoTC a 893 pacientes, demostrandose ETE en 240. Al desglosar estos diagnosticos, existia TEP en 218 pacientes (24,4%), aislado en 139 (63,7%) y concomitante con TVP en 79 pacientes (36,2 %). Se observo evidencia radiografica de sobrecarga ventricular derecha en 35 de los 218 pacientes con TEP . En otros 22 pacientes se diagnostico TVP aislada (10%). En consecuencia, el estudio del sistema venoso profundo incremento el rendimiento diagnostico de la tomografia en 2,46% (p En 65 de los 218 pacientes (30%) con TEP se observo una lesion de aspecto neoplasico, nueva o antigua. En los 653 casos negativos para ETE, 71 examenes (11%) presentaron hallazgos patologicos significativos. Conclusione s: El uso combinado de angiografia pulmonar por TC y venografia por TC empleando un tomografo multidetector de 64 canales aumenta el rendimiento diagnostico de la enfermedad tromboembolica. Asimismo, frecuentemente permite diagnosticar otras patologias concomitantes, en general de naturaleza neoplasica, relacionadas o no con la presencia de ETE.

Aim: The aims of this study were to validate a randomized, split-mouth, localized experimental gingivitis model and to identify subjects with different gingivitis susceptibility. Material and Methods: In each of 96 healthy subjects, one maxillary quadrant was randomly assigned as "test" (experimental gingivitis) and the contralateral quadrant as "control". Plaque index (PlI), gingival index (GI), gingival crevicular fluid volume (GCF), and angulated bleeding score (AngBS) were recorded in both quadrants at days 0, 7, 14, and 21. Cumulative plaque exposure (CPE), i.e. PlI over time, was calculated. Day-21 GCF was standardized according to CPE, and residuals of GCF on CPE were calculated. Two subpopulations were then defined, based on upper and lower quartiles of GCF-residual distribution and were, respectively, identified as "high-responder" (HR; n = 24) and "low-responder" (LR; n = 24). Results: At test quadrants, all parameters significantly increased throughout the trial, while in control quadrants, PlI, GI, and AngBS remained low. Significant differences were noted between test and control quadrants on days 7, 14, and 21 for all parameters. Significant increases in GI, AngBS, and GCF were observed in test quadrants over the course of the study in both HR and LR groups. Significant differences were noted between HR and LR groups for all gingivitis parameters on day 21 in test quadrants, without any significant differences in PlI or CPE between the groups. Conclusions: We identified two subpopulations characterized by significant differences in clinical parameters of plaque-induced gingival inflammation, despite similar amounts of plaque deposits and plaque accumulation rates.

BackgroundIn most countries, men seem to be more susceptible to tuberculosis (TB) than women, but only few studies have investigated the reasons of this gender incidence difference. The effect of sexual hormones on immunity is possible.MethodsData from children and adults, living in Tuscany, hospitalized for TB in all the thirty-one regional hospitals from January 1st 1997 to December 31st 2011, were analyzed using the International Classification of Disease, 9th Revision, Clinical Modification.ResultsDuring the study period, 10,744 patients were hospitalized with TB diagnosis, precisely 279 (2.6%) children [0-14 years], 205 (1.9%) adolescents [15-18 years] and 10,260 (95.5%) adults [≥ 18 years]. The male population ranged from 249 patients (51.4%) in children and adolescents, to 6,253 (60.9%) in adults. Pulmonary TB was the most common form both in children and adults. Men were more likely than women to have pulmonary TB after puberty, while no significant differences were found between males and females in the hospitalized children. The male gender also resulted the most affected for the extra-pulmonary disease sites, excluding the lymphatic system, during the reproductive age.ConclusionsOur findings suggest a possible role of sexual hormones in the development of TB. No significant male-female difference was found in TB incidence among children, while a sex ratio significantly different from 1:1 emerged among reproductive age classes. An increased incidence difference also persisted in older men, suggesting that male-biased risk factors could influence TB progression. Some limitations of the study are the sample size, the method of discharge diagnosis which could be deficient in accuracy in some cases, the increasing number of immigrants and the lack of possible individual risk factors (smoke and alcohol). Further studies are needed to investigate the possible hormone-driven immune mechanisms determining the sexual dimorphism in TB.

Data from 484 children (median age: 6 years; 46.5% immigrants) hospitalized for tuberculosis in 31 Tuscan hospitals in 1997-2011 were analyzed. Incidence increased from 7.3 (95% confidence interval: 4.9-9.4) to 12.5 (95% confidence interval: 9.6-15.4) per 100,000 (P=0.009). Increases were particularly profound in children

e17081Background: Obesity is a public health problem in most developed countries, with growing incidence in the last decades. Epidemiologic studies associate obesity with increased risk of developi...

Italy is the Country with the highest life expectancy in the world, and over 75,000 elderly people experience a hip fracture each year.following the Tuscany TARGET protocol, we aimed to estimate the costs of pharmacological treatment in the hypothesis of treating all elderly Italian people with hip fractures.we analyzed the Tuscany healthcare system databases at the beginning of the Tuscany TARGET project for the prevention of hip fractures in elderly patients, and the Italian national hospitalizations records and DRGs databases concerning hip fractures occurred between 2000 and 2005.costs sustained for pharmacological treatments effective in reducing the risk of subsequent hip fractures all over Italy would account for 17.5 million Euros, representing only 0.18% of the overall national pharmaceuticals expenditures, while the national healthcare service is currently spending more than 30% of the overall pharmaceuticals expenditures in providing cardiovascular-active drugs.The burden of hip fractures in the Italian elderly population is substantial and must be acknowledged as an important health problem. Specific preventive strategies, such as the Tuscany TARGET project should be implemented in all Italian regions.

CT pulmonary angiography is the diagnostic procedure of choice for non-massive pulmonary embolism.To assess the diagnostic yield for thromboembolic disease of CT pulmonary angiography and venography using a 64-slice multidetector tomography.Prospective study of patients with a clinical suspicion of thromboembolic disease, subjected to CT pulmonary angiography and venography. The presence and location of pulmonary thromboembolism, of isolated or concomitant deep venous thrombosis and of other significant radiological findings, were registered.A 64-MDCT scanner was performed to 893 patients and thromboembolic disease was demonstrated in 240. Pulmonary thromboembolism was diagnosed in 218 patients. It was concomitant with deep venous thrombosis in 79 patients (36%) and isolated in the rest. Thirty five of the 218 patients with pulmonary thromboembolism had radiological evidence of right ventricular overload. Twenty two patients (10%) had an isolated deep venous thrombosis. In 65 patients with pulmonary thromboembolism (30%) a possibly new or old malignant lesion, was observed. Seventy one of 653 patients without evidence of thromboembolic disease had potentially pathological findings on CT.The combined use of CT pulmonary arteriography and venography using a 64 MDCT scanner increases the diagnostic yield of the procedure for thromboembolic disease. It also allows the diagnosis of other related conditions, specially malignant tumors.

To assess quantitative serology in chronic hepatitis B virus (HBV) infection, testing by novel immunoassays has been carried out on 202 specimens from untreated patients and in 83 samples from 10 patients with chronic hepatitis B treated with lamivudine. Serum samples were assayed for quantitative HBsAg, in comparison with quantitative HBV-DNA, and for anti-HBc IgM and the avidity index (AI) of total anti-HBc antibodies. The AI was high (mean: 0.93 +/- 0.19) in all groups, confirming the consistency of this procedure in chronic HBV infections. A low-level positivity (2-28 Paul-Ehrlich units/ml) for IgM anti-HBc was detectable both in HBeAg-positive and in HBeAg-negative untreated chronic hepatitis cases (mean S/CO values by the Abbott Architect assay: 0.51 +/- 0.12 and 0.48 +/- 0.10, respectively; correlation between assays: r = 0.685), while treated patients (mean: 0.20 +/- 0.15) and inactive carriers (mean: 0.17 +/- 0.21), were generally negative for IgM. The levels of HBsAg (IU/ml) showed a weak correlation with HBV-DNA (IU/ml). A difference in HBsAg levels was found between inactive carriers (1,935 +/- 2,887 IU/ml) and chronic hepatitis B cases, either treated (5,199 +/- 9,259 IU/ml) or untreated (14,596 +/- 15,227 IU/ml). Pre-treatment levels of HBsAg in patients undergoing lamivudine treatment were correlated with a sustained response to therapy over 13-33 months (mean: 27.3) of follow-up: mean HBsAg values were 1,576 + 1,487 IU/ml in five responders and 6,063 + 5,142 in five nonresponders or breakthrough responders (P < 0.05). The availability of standardized quantitative immunoassays for HBsAg and anti-HBc IgM may be considered in addition to quantitative HBV-DNA in the staging and monitoring of chronic HBV infection.

Aim: The aim of the present study was to characterize the subject-based clinical behavior of the gingiva in response to a tooth-cleaning regimen in two subpopulations, “high-responder” (HR) and “low-responder” (LR) groups, presenting a different inflammatory response to plaque accumulation. Material and Methods: The study population comprised of 96 systemically and periodontally healthy subjects, 46 males and 50 females, non-smokers, enrolled in an experimental gingivitis trial. At completion of the experimental gingivitis period (day 21), all subjects were prescribed the same 21-day treatment regimen of amine/stannous fluoride (AmF/SnF2)-containing toothpaste and mouthrinse. Plaque index (PlI), gingival index (GI), gingival crevicular fluid volume (GCF), and angulated bleeding score (AngBS) were recorded on three selected teeth. Treatment efficacy was evaluated in the overall population as well as in HR and LR groups, separately. Results: A statistically significant decrease of PlI was observed after treatment (p

We have measured plasma aldosterone, plasma cortisol, and glucocorticoid and mineralocorticoid receptors in mononuclear leukocytes in 54 healthy aged subjects (60-97 years old) and in a group of 21 controls (21-50 years old). In addition all parameters and age were plotted for correlation. Plasma cortisol was significantly higher in the aged group (346 +/- 140 nmol/l) than in controls (260 +/- 120). Mean plasma aldosterone was not different in the two groups. Both Type I and II receptors in mononuclear leukocytes were lower in the aged group than in controls (Type I 198 +/- 96 and 272 +/- 97 receptors per cell; Type II 1738 +/- 801 and 3339 +/- 918 receptors per cell). A direct correlation was found between cortisol and age and between Type I and II receptors in aged subjects, and between cortisol and Type I receptors, and cortisol and Type II receptors in controls. When all subjects are plotted together, a direct correlation was observed between cortisol and age and between Type I and II receptors, and an inverse correlation between age and Type I and age and Type II receptors. We conclude that the parallel reduction of both Type I and II receptors with age is not due to prior cortisol increase, but the increase of plasma cortisol can be considered the result of age-dependent involution of these receptors.

To provide epidemiological data on community-acquired pneumonia (CAP) and complicated CAP, a retrospective study was conducted on a partially vaccinated paediatric population. Data from children hospitalized for CAP in Tuscan hospitals between January 1st, 1999 and December 31st, 2009 were analysed. A total of 5,450 children with CAP were hospitalized. Annual hospitalization rates for CAP did not change significantly over the study period (χ2 for trend= 0.652; p=0.419). The total annual hospitalization rate for pneumococcal CAP varied according to age (28.04 per 100,000 children aged ≤ 5 years, 10.06 per 100,000 children aged 6–12 years and 0.98 per 100,000 children aged ≥ 13years). Hospitalization rates for pneumococcal CAP increased from 12.84 (95% CI:7.35–18.34) in 2001 to 45.4 (95%CI:35.93–54.90) per 100,000 children aged ≤ 5 years in 2009 (p