Pneumonia can be caused by a variety of viruses, bacteria, and fungi. Pneumonia can have severe health effects, leading to hospitalization and even death among the elderly and other at-risk populations. Per the CDC, an estimated 1 million people seek care in hospitals for pneumonia, of all causes, with approximately 50,000 dying from the disease each year.

The most common cause of pneumonia is the bacteria Streptococcus pneumoniae, or pneumococcus, which can also lead to other forms of pneumococcal disease ranging from ear and sinus infections to potentially life-threatening meningitis and bloodstream infections. Pneumonia is the most common form of pneumococcal disease in adults.

There are two types of vaccines – pneumococcal conjugate and pneumococcal polysaccharide – both of which help protect against pneumococcal disease, including pneumonia. One dose of the conjugate vaccine protects around 45 in 100 adults age 65 and older against pneumonia, while one dose of either vaccine protects 50 to 85 percent of adults against invasive pneumococcal disease.

Despite its ability to cause serious illness, accurately identifying pneumococcal pneumonia is challenging for clinicians. Conventional methods of identification are relatively slow and show limited specificity. In addition, Streptococcus pneumoniae bacteria can colonize the upper respiratory tract without causing a symptomatic infection.^1,2

A review of New Jersey claims data helps to highlight just how high the proportion of pneumonia cases with an “unidentified” cause is in hospital settings. In 2018, New Jersey hospital claims included 194 inpatient admissions and 30 emergency department visits that were specifically coded with a primary diagnosis of “pneumonia due to Streptococcus pneumoniae.” However, the vast majority of pneumonia-related cases in both settings were coded with the broader “pneumonia, unspecified organism.” Of the total all-cause pneumonia cases in 2018, 13,012 inpatient admissions (76.7 percent) and 15,262 emergency department visits (75.4 percent) were coded as unspecified.

Statewide rates for overall pneumococcal disease have increased slightly from 2014 to 2018, but in general are relatively stable. The most noticeable spike occurred in 2017 when the rate of Streptococcus pneumoniae jumped to 7.7 cases per 100,000 population from 6.5 in the prior year. While not confirmed, the particularly virulent flu season may have had an impact on the increase in the pneumococcal disease rate.