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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Streptococcus pneumoniae</span> is a major cause of invasive diseases &#40;IPD&#41; such as meningitis&#44; bacteremic pneumonia and sepsis&#44; associated with high morbimortality&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> IPD affects all age groups&#44; particularly children &#8804;5 years-old and the elderly&#44; with the highest case fatality rates in individuals with chronic underlying diseases and immunocompromising conditions&#46;<a class="elsevierStyleCrossRefs" href="#bib0002"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="para0006" class="elsevierStylePara elsevierViewall">Pneumococcal vaccines are effective in preventing IPD&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> Globally&#44; the polysaccharide 23-valente vaccine &#40;PPV23&#41;&#44; and the conjugate vaccines&#44; 10-valent &#40;PCV10&#41; and the 13-valent &#40;PCV13&#41; vaccines are widely used&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> In Brazil&#44; two pneumococcal vaccines are available free of charge in the Public Health System of &#40;SUS&#41;&#46; PCV10 is the vaccine routinely used in the National Immunization Program &#40;NIP&#41; for &#60; 2 years-old&#44; and the PPV23 is recommended for children aged &#8805; 2 years&#44; adolescents and adults who have certain medical conditions and long-term care facility residents aged &#8805; 60 years&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> PCV13 is available in private vaccination clinics and&#44; since 2019&#44; this vaccine was included in the NIP but restricted to individuals with underlying conditions &#40;HIV&#47;AIDS&#44; oncologic&#44; and bone marrow and solid organ transplants&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">Due to widespread PCV-implementation&#44; emergency of serotypes not included in the vaccines &#40;serotype-replacement&#41; became an important concern leading to the development of new-generation PCVs with expanded valence of serotypes&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> Inappropriate antimicrobial use has also contributed to the emergency of non-vaccine-serotypes associated with antimicrobial resistance&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> PCV15 and PCV20 were recently licensed in the United States&#44; respectively for individuals six weeks of age and older&#44; and adults aged &#8805; 18 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0013"><span class="elsevierStyleSup">13&#8211;15</span></a></p><p id="para0008" class="elsevierStylePara elsevierViewall">The PCV21 vaccine is under development&#46;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> The broader spectrum of the pneumococcal serotypes in PPV23 is an advantage over currently PCVs&#44; but this vaccine has been shown to be less effective in older adults and those with comorbidities&#44; in addition to a short duration of protection&#46; Furthermore&#44; the PPV23 has no effect against the acquisition of carriage&#44; a prerequisite for herd protection&#46;<a class="elsevierStyleCrossRefs" href="#bib0017"><span class="elsevierStyleSup">17&#8211;19</span></a></p><p id="para0009" class="elsevierStylePara elsevierViewall">Brazil has a well-established national laboratory-based surveillance of invasive diseases&#44; but there is no population surveillance except for meningitis&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> Thus&#44; limited data are available on the clinical characteristics of hospitalized patients with IPD&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a></p><p id="para0010" class="elsevierStylePara elsevierViewall">The present study aimed to assess the clinical presentation and outcomes of patients with IPD admitted to tertiary care hospitals and to describe the serotypes and antimicrobial-non-susceptibility of the pneumococcal isolates&#46; We also estimated the extent of serotype-coverage for each available vaccine&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Material and methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Study design and population</span><p id="para0011" class="elsevierStylePara elsevierViewall">This was a retrospective descriptive study using clinical&#44; 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were selected&#46;</p><p id="para0013" class="elsevierStylePara elsevierViewall">The electronic hospital record of each patient &#40;personal variables&#44; medical history and clinical outcome&#41; was reviewed by the hospital staff who completed the study data collection form&#46; In each hospital center&#44; a clinical supervisor was responsible for training the hospital staff to fill in the standardized form and for checking any clinical inconsistencies&#46; Patients of all age groups were included in the study&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Microbiology methods</span><p id="para0014" class="elsevierStylePara elsevierViewall">Pneumococcal isolates were routinely sent to IAL by hospitals along with patient data&#46; Species identification was confirmed by standard methods&#46;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> Pneumococcus was serotyped by the Quellung reaction with antisera from the Statens Serum Institute &#40;Copenhagen&#44; Denmark&#41;&#46; Non-typeable &#40;NT&#41; isolates by Quellung reaction were confirmed by PCR-multiplex&#46;<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a></p><p id="para0015" class="elsevierStylePara elsevierViewall">Susceptibility to erythromycin&#44; clindamycin&#44; sulfamethoxazole-trimethoprim&#44; levofloxacin&#44; tetracycline and vancomycin was assessed using the disk-diffusion test following the Clinical and Laboratory Standards Institute &#40;CLSI&#41; guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> Susceptibility to beta-lactamics was assessed by determining the minimum inhibitory concentration &#40;MIC&#41; by the E-test &#40;AB BIODISK&#44; Solna&#44; Sweden&#41;&#46; Non-susceptibility to penicillin and ceftriaxone &#40;intermediate plus resistant&#41; were defined as MIC &#8805; 0&#46;12 mg&#47;L and &#8805; 1&#46;0 mg&#47;L for meningitis and the corresponding MIC &#8805; 4&#46;0 mg&#47;L and &#8805; 2&#46;0 mg&#47;L for non-meningitis isolates&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Data analysis</span><p id="para0016" class="elsevierStylePara elsevierViewall">Clinical information and laboratory records in Excel spreadsheets were linked&#46; Only one pneumococcal isolate per hospitalization episode was included in the analysis&#46; For some cases&#44; clinical data were lacking&#46; For a few isolates&#44; serotype or non-susceptibility data were missing&#46; For the analysis&#44; the following age groups were considered &#60; 5y&#44; 5-17y&#44; 18-49y&#44; 50-64y and &#8805; 65y&#46;</p><p id="para0017" class="elsevierStylePara elsevierViewall">Patients were classified according to their medical risk profile for IPD into three categories&#58; &#40;1&#41; <span class="elsevierStyleItalic">healthy&#44;</span> patients without pre-existing comorbidities&#59; &#40;2&#41; <span class="elsevierStyleItalic">high-risk conditions</span> that included immunocompromised patients and those with other disorders &#40;cancer&#44; HIV&#47;AIDS&#44; HTLV&#44; hematologic disorder&#44; chronic renal diseases&#44; bone marrow&#47;solid organ transplant&#44; cerebrospinal leak&#44; cochlear implant&#44; and functional&#47;anatomic asplenia&#41;&#44; and &#40;3&#41; <span class="elsevierStyleItalic">at-risk conditions</span> that included immunocompetent persons with specific underlying medical conditions &#40;asthma&#44; diabetes mellitus&#44; chronic liver diseases&#44; chronic heart diseases&#44; chronic lung diseases&#44; lupus&#44; Crohn&#180;s diseases&#44; rheumatoid arthritis&#44; and other unspecified chronic disease&#41; according to previous reports&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a> Patients presenting simultaneous at-risk and high-risk conditions were included in the high-risk category&#46; Those with missing data for each of the recorded comorbidities were classified as having an ignored risk profile&#46; The sum of comorbidities included in the at-risk and high-risk categories were also recorded&#46; Categorical variables were expressed as proportions&#46; Antimicrobial-non-susceptibility rate was calculated by the arithmetic mean of number of non-susceptible isolates divided by the number of tested isolates&#46; Multidrug-resistance was defined as non-susceptibility to at least three antimicrobial classes&#46; Vaccine-serotype coverage was calculated by the proportion of pooled PCV-serotypes in each vaccine formulations divided by the total number of isolates&#46; Coverage was calculated stratified by age group&#44; clinical condition&#44; and antimicrobial-non-susceptibility&#46; PCV-formulations were&#58; PCV10-types &#40;serotypes 1&#44; 4&#44; 5&#44; 6B&#44; 7F&#44; 9V&#44; 14&#44; 18C&#44; 19F and 23F&#41;&#59; additional-PCV13 &#40;3&#44; 6A and 19A&#41;&#59; additional-PCV15-types &#40;22F and 33F&#41;&#59; additional-PCV20-types &#40;8&#44; 10A&#44; 11A&#44; 12F and 15B&#41;&#59; PCV21-types &#40;3&#44; 6A&#44; 7F&#44; 8&#44; 9N&#44; 10A&#44; 11A&#44; 12F&#44; 15A&#44; 16F&#44; 17F&#44; 19A&#44; 20&#44; 22F&#44; 23A&#44; 23B&#44; 33F&#44; 24F&#44; 31 and 35B&#41;&#59; PPV23-types &#40;1&#44; 2&#44; 3&#44; 4&#44; 5&#44; 6B&#44; 7F&#44; 8&#44; 9N&#44; 9V&#44; 10A&#44; 11A&#44; 12F&#44; 14&#44; 15B&#44; 17F&#44; 18C&#44; 19A&#44; 19F&#44; 20&#44; 22F&#44; 23F and 33F&#41;&#46; Comparisons of proportions across strata were done using the Chi-square or the Fisher&#39;s exact test&#44; as appropriate&#44; in the software STATA&#46;</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Ethics</span><p id="para0018" class="elsevierStylePara elsevierViewall">The study was submitted to the Ethics Committees of the institutions participating in the study&#46; The research was developed observing the recommendations of Resolution No&#46;196 dated 10&#47;10&#47;96 - Conselho Nacional de Sa&#250;de para Pesquisa Cient&#237;fica em Seres Humanos &#91;National Health Council for Scientific Research in Human Beings&#93;&#46;</p></span></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Results</span><p id="para0019" class="elsevierStylePara elsevierViewall">A total of 406 patients &#91;HC &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;195&#44; 48&#37;&#41;&#44; IIER &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;62&#44; 15&#46;3&#37;&#41;&#44; HSPE &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;58&#44; 14&#46;3&#37;&#41;&#44; HU &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;49&#44; 12&#46;1&#37;&#41;&#44; and ISCMSP &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;42&#44; 10&#46;3&#37;&#41;&#93; with their corresponding <span class="elsevierStyleItalic">S&#46; pneumoniae</span> characterization were included in the study&#46; Patients were mostly male &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;232&#44; 57&#46;1&#37;&#41;&#46; Pneumonia was the predominant IPD manifestation &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;236&#44; 58&#46;1&#37;&#41;&#44; followed by meningitis &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;29&#44; 7&#46;1&#37;&#41;&#46; There were 88 patients &#40;21&#46;7&#37;&#41; with other conditions &#40;bacteremia&#44; sepsis&#44; abscess&#44; and ascites&#41; and 53 patients &#40;13&#46;1&#37;&#41; with unknown manifestations&#46; The number of cases by age group was&#58; &#60; 5y &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;48&#44; 11&#46;8&#37;&#41;&#44; 5-17y &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;20&#44; 4&#46;9&#37;&#41;&#44; 18-49y &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;127&#44; 31&#46;3&#37;&#41;&#44; 50-64y &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;104&#44; 25&#46;6&#37;&#41; and &#8805; 65y &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;107&#44; 26&#46;4&#37;&#41;</p><p id="para0020" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a> displays the distribution of IPD cases according to the presence of specific medical conditions by age group&#46; Among the 406 patients&#44; information of medical condition was available for 324 patients &#40;79&#46;8&#37;&#41;&#44; of which 63 &#40;19&#46;5&#37;&#41; patients informed no previous medical condition&#44; therefore included in the healthy category&#44; and 261 cases &#40;80&#46;5&#37;&#41; reported the presence of at least one medical condition&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0021" class="elsevierStylePara elsevierViewall">The presence of a previous medical condition was significantly lower in the age group of young children &#60; 5y &#40;44&#46;1&#37;&#41;&#44; when comparing to the other age groups &#40;&#62; 80&#37;&#41;&#46; Overall&#44; presence of one comorbidity by patient &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;162&#44; 62&#46;1&#37;&#41; was more frequent than &#8805; 2 comorbidities &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;99&#44; 37&#46;9&#37;&#41;&#44; and was observed in all age groups&#46; Young children had a much higher proportion of a single comorbidity &#40;86&#46;7&#37;&#41;&#44; as compared to the other age groups &#40;&#60; 65&#46;2&#37;&#41;&#46; The presence of high-risk conditions was higher than that of at-risk conditions in all age groups&#46; Simultaneous high-risk&#47;at-risk conditions were present in 52 cases&#44; predominating among &#8805; 18y &#40;96&#46;1&#37;&#41;&#46; Patients without information on medical conditions &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;82&#44; 20&#46;2&#37;&#41; were not equally distributed across the age groups&#44; but without a clear trend &#40;Supplementary Table S1&#41;&#46;</p><p id="para0022" class="elsevierStylePara elsevierViewall">Distribution of specific high-risk and at-risk comorbidities among 261 IPD cases by age group is shown in Supplementary Table S2&#46; Cancer was the most common comorbidity &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;73&#44; 28&#37;&#41;&#44; followed by HIV-AIDS &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;67&#44; 25&#46;7&#37;&#41; and hematological diseases &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;64&#44; including nine sickle cell anemia patients&#44; 24&#46;5&#37;&#41;&#46; Among the at-risk conditions&#44; asthma &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;43&#44; 16&#46;5&#37;&#41; was the most frequent&#46; The distribution of specific comorbidities varied a lot by age group&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a> displays the outcome status for the 283 patients for whom this information was available&#46; Death occurred in 81 patients &#40;28&#46;6&#37;&#41;&#44; increasing with the advancing age&#46; Among those with IPD diagnosis&#44; meningitis &#40;54&#46;2&#37;&#41; presented higher death rate compared with pneumonia &#40;26&#46;8&#37;&#41; and other IPD &#40;25&#46;3&#37;&#41;&#46; Contrary to our expectations&#44; the proportion of deaths did not increase with increasing comorbidity status or with having one or more comorbidities&#46; Of the total 406 IPD patients&#44; unfortunately there were many missing information on outcome status &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;105&#44; 25&#46;9&#37;&#41; and some were transferred out &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;18&#44; 4&#46;4&#37;&#41;&#46; They were not equally distributed across age groups&#44; IPD diagnosis and comorbidity status&#44; as shown in Supplementary Table S3&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0024" class="elsevierStylePara elsevierViewall">Of the 406 isolates&#44; blood was the predominant source of the specimen &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;357&#59; 87&#46;9&#37;&#41;&#44; followed by cerebrospinal fluid &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;20&#44; 4&#46;9&#37;&#41;&#46; Other body fluids &#40;pleural fluid&#44; abscess&#44; ascites&#44; bronchial alveolar lavage&#44; vitreous humor&#44; and synovial liquid&#41; were the source for 21 patients &#40;5&#46;2&#37;&#41; and for eight patients &#40;2&#46;0&#37;&#41; the source was ignored&#46;</p><p id="para0025" class="elsevierStylePara elsevierViewall">Distribution of serotypes by age group is displayed in <a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>&#46; Forty-three serotypes plus one NT isolate were identified&#46; Overall&#44; five serotypes were responsible for 42&#46;9&#37; of the isolates&#46; Serotype 19A was the predominant type &#40;14&#46;1&#37;&#41; followed by serotypes 3 &#40;8&#46;7&#37;&#41;&#44; 6C &#40;7&#46;7&#37;&#41;&#44; 4 and 8 &#40;6&#46;2&#37; each&#41;&#46; Considering the age groups&#44; serotype 19A was more frequent in &#60; 5y &#40;37&#46;5&#37;&#41; and 18-49y &#40;11&#46;8&#37;&#41;&#44; while serotype 3 was prevalent in 50-64y &#40;12&#46;6&#37;&#41; and &#8805; 65y &#40;12&#46;3&#37;&#41;&#46; Serotypes 6C &#40;8&#46;0&#37;&#41;&#44; 4 &#40;7&#46;4&#37;&#41; and 8 &#40;7&#46;1&#37;&#41; occurred mostly in those aged &#8805; 18y&#46;</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia><p id="para0026" class="elsevierStylePara elsevierViewall">Rates of antimicrobial-non-susceptibility to penicillin and ceftriaxone among meningitis isolates were respectively 20&#46;7&#37; and 3&#46;4&#37;&#46; Antimicrobial non-susceptibility&#44; including meningitis and non-meningitis isolates&#44; to erythromycin&#44; clindamycin&#44; sulfamethoxazole-trimethoprim and tetracycline varied from 21&#46;1&#37; to 33&#46;2&#37;&#46; Only two isolates &#40;0&#46;5&#37;&#41; showed levofloxacin non-susceptibility&#59; all isolates were vancomycin susceptible&#46; Multidrug-resistance was identified in 13&#46;0&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0004">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0004"></elsevierMultimedia><p id="para0027" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 5</a> shows vaccine-serotype-coverage by age&#44; risk-group and antimicrobial-non-susceptibility&#46; As expected&#44; there was a trend towards increasing serotype-coverage with increasing vaccine valence&#44; but even PCV21 only covered 65&#46;8&#37; of all isolates&#46; Serotype-coverage for PCV10 was 19&#46;1&#37;&#44; with lower coverage among children &#60; 5y &#40;4&#46;2&#37;&#41; and 5-7 &#40;5&#37;&#41; as compared to the older age groups&#46; Serotype-coverage for the other vaccines varied by age&#44; but no clear trend was observed&#46; Regarding risk groups&#44; serotype-coverage for all vaccines was higher in health individuals as compared to those with comorbidities&#44; but differences were mostly small&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="para0028" class="elsevierStylePara elsevierViewall">Antimicrobial non-susceptibility was present in 0&#37; for vancomycin&#44; 0&#46;5&#37; &#40;2&#47;378&#41; for levofloxacin&#44; 2&#37; &#40;8&#47;405&#41; for ceftriaxone&#44; 5&#46;9&#37; &#40;24&#47;403&#41; for penicillin&#44; 21&#46;1&#37; &#40;83&#47;394&#41; for clindamycin&#44; 26&#46;7&#37; &#40;108&#47;404&#41; for erythromycin&#44; 33&#46;2&#37; &#40;134&#47;404&#41; for sulfamethoxazole-trimethoprim&#44; 47&#37; &#40;178&#47; 379&#41; for tetracycline and&#44; finally&#44; 13&#46;1&#37; &#40;53&#47;406&#41; were multidrug-resistant&#46; The lower part of <a class="elsevierStyleCrossRef" href="#tbl0005">Table 5</a> shows the isolates not susceptible to each of the antibiotics and the proportion of them that were serotypes covered by each vaccine&#46; For all antibiotics&#44; the PCV10 vaccine only covered a minority of non-susceptible isolates&#46; Although the serotype-coverage increased significantly for the other vaccines&#44; it should be noted that it was only 100&#37; for ceftriaxone with PCV21&#46; For tetracycline&#44; for example&#44; out of the total of 178 non-susceptible isolates&#44; only 79 &#40;44&#46;4&#37;&#41; had serotypes covered by the PCV15 vaccine&#46;</p><p id="para0029" class="elsevierStylePara elsevierViewall">Distribution of serotypes by antimicrobial-non-susceptibility by PCV-formulation is available in a Supplementary Table S4&#46; Serotype 19A &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;57&#41;&#44; included in all PCVs but PCV10&#44; was associated to non-susceptibility to penicillin &#40;24&#46;6&#37;&#41;&#44; tetracycline &#40;70&#46;2&#37;&#41;&#44; sulfamethoxazole-trimethoprim &#40;75&#46;4&#37;&#41;&#44; erythromycin &#40;70&#46;2&#37;&#41; and clindamycin &#40;57&#46;9&#37;&#41;&#44; and multidrug-resistance &#40;50&#46;9&#37;&#41;&#46; Serotype 6C &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;31&#41;&#44; a non-vaccine-type&#44; expressed non-susceptibility to tetracycline &#40;71&#46;0&#41;&#44; sulfamethoxazole-trimethoprim &#40;32&#46;3&#37;&#41;&#44; erythromycin &#40;67&#46;7&#37;&#41; and clindamycin &#40;61&#46;3&#37;&#41;&#46; Serotypes most associated with tetracycline-non-susceptibility were 8 &#40;44&#46;0&#37;&#41;&#44; 10A&#44; 35B &#40;75&#37; each&#41;&#44; and 20 &#40;90&#46;0&#37;&#41;&#44; included in PVC20 and PCV21&#44; and PPV23&#46;</p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Discussion</span><p id="para0030" class="elsevierStylePara elsevierViewall">This study investigates the clinical conditions of inpatients with IPD&#44; and the corresponding characteristics of the pneumococcal isolates at large hospitals that treat cases with clinical complexity in S&#227;o Paulo&#46;</p><p id="para0031" class="elsevierStylePara elsevierViewall">The study involved a low proportion of inpatients aged &#60; 5y and 5-17y versus &#8805; 18y&#44; evidencing advanced age associated with medical complication as a risk-factor for acquiring IPD&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> In that regard&#44; the substantial contribution of the widespread use of PCV10 in Brazil leading to a decline in IPD in the pediatric population was also evident&#44; as reported by others&#46;<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a></p><p id="para0032" class="elsevierStylePara elsevierViewall">Overall&#44; most patients presented only one risk-factor &#40;60&#46;6&#37;&#41; and high-risk comorbidities occurred more frequently &#40;62&#46;2&#37;&#41; than at-risk comorbidities &#40;18&#46;3&#37;&#41;&#46; Cancer&#44; HIV&#47;AIDS&#44; hematologic disorder were the most common comorbid conditions&#44; occurring mostly in patients aged &#8805; 18 years&#46; Asthma was also frequent in those aged &#8805; 18 years&#44; while diabetes occurred furthermost in older adults&#44; particularly those aged &#8805; 65 years&#46; Corroborating with these findings&#44; population-based-surveillance studies conducted in the United States and England reported that more than 50&#37; of IPD occurred in adults aged &#8805; 18 years were associated with cancer&#44; HIV&#47;AIDS&#44; diabetes&#44; chronic heart disease and chronic lung disease&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> Another national-surveillance study conducted in Denmark reported increased risk of IPD in the presence of hematological malignancies in &#62; 15 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="para0033" class="elsevierStylePara elsevierViewall">Regarding the outcome&#44; we found a statistically significant increase in mortality with advancing age&#44; reaching 42&#46;7&#37; at &#8805; 65 years&#44; reflecting the high IPD risk conditions among the elderly with waning immunocompetence&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0032"><span class="elsevierStyleSup">32</span></a> Conversely&#44; as expected&#44; children had a higher cure rate &#40;89&#46;7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> Crude associations of higher mortality with comorbidity status and number of comorbid conditions were not observed in our study&#44; which may be related to the high proportion of missing data on comorbidities &#40;20&#46;2&#37;&#41; and on outcome status &#40;25&#46;9&#37;&#41; in this study&#46; However&#44; the association between higher risk conditions and bad prognosis for IPD has been widely reported by other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0033"><span class="elsevierStyleSup">33&#8211;35</span></a> Meningitis&#44; a serious neurological disease&#44; was more deadly &#40;54&#46;2&#37;&#41; than pneumonia &#40;26&#46;8&#37;&#41; and other IPD &#40;24&#46;6&#37;&#41;&#44; as expected&#46;</p><p id="para0034" class="elsevierStylePara elsevierViewall">Globally even with the substantial PCVs success in reducing IPD&#44; children&#44; the elderly and patients with comorbidities are still populations at risk for IPD&#44; due to the occurrence of serotype replacement&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> Thus&#44; the global scenario is still challenging for IPD prevention&#46; Currently&#44; about 100 pneumococcal serotypes have been identified&#44; based on their unique polysaccharide capsule&#44; each one with different propensities to develop IPD&#46;<a class="elsevierStyleCrossRef" href="#bib0036"><span class="elsevierStyleSup">36</span></a> Here we observe low rates of PCV10 serotypes in children and in older adults in consequence of the direct and indirect effect &#40;herd immunity&#41; of PCV10 vaccination&#44; even with suboptimal vaccine-coverage of approximately 88&#37; with two doses in the city of S&#227;o Paulo during the study-period&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0037"><span class="elsevierStyleSup">37</span></a></p><p id="para0035" class="elsevierStylePara elsevierViewall">We found high diversity of serotypes&#44; showing the high rates of the additional PCV-types 19A and 3&#44; and the non-PCV-type 6C&#44; which is in accordance with data from Brazilian national-laboratory-surveillance and from other countries where PCV10 had been introduced in their vaccination program&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0038"><span class="elsevierStyleSup">38&#8211;41</span></a> A high rate of 19A is likewise worrisome because of its relatively high potential for causing IPD&#44; and its association with antimicrobial-non-susceptibility&#44; similarly to what is observed for 6C&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0036"><span class="elsevierStyleSup">36</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0038"><span class="elsevierStyleSup">38</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">40&#8211;43</span></a> Regarding serotype 3&#44; a PCV13-serotype&#44; although not associated with antimicrobial non-susceptibility&#44; there is a concern about its high prevalence&#44; because it causes high morbidity even in countries where PCV13 vaccine have been introduced&#44; due to the abundant expression of its capsule that limits vaccine efficacy&#46;<a class="elsevierStyleCrossRefs" href="#bib0044"><span class="elsevierStyleSup">44&#8211;47</span></a></p><p id="para0036" class="elsevierStylePara elsevierViewall">Treatment of IPD with antimicrobials is decisive in the course and outcome of the disease&#46; We observed dramatic rates of antimicrobial-non-susceptibility &#40;&#62; 20&#37;&#41; for some drugs and multidrug-resistance &#40;13&#37;&#41;&#44; which can be a challenge for the IPD clinical management&#46; Importantly&#44; we found a low non-susceptibility to ceftriaxone &#40;&#60; 3&#46;5&#37;&#41;&#44; and none isolate expressed non-susceptibility to vancomycin&#44; in line with the findings of other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> These drugs are routinely prescribed to hospitalized patients with risk conditions for IPD&#46;</p><p id="para0037" class="elsevierStylePara elsevierViewall">PCVs with expanding serotype-valence including the additional serotypes 19A&#44; 6A &#40;6A may induce cross-protection with 6C<a class="elsevierStyleCrossRef" href="#bib0048"><span class="elsevierStyleSup">48</span></a>&#41; besides other additional types afford growing benefits to prevent IPD in the post-PCV10 period&#46; Regarding the PPV23&#44; we found higher serotype-coverage &#40;67&#46;3&#37;&#41; than the 31&#46;4&#37; reported among patients admitted to a tertiary care hospital located in the city of Porto Alegre&#44; in Brazil&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> In addition&#44; in the present study&#44; PPV23 coverage did not vary by age groups or presence of risk conditions&#44; which was similar to the findings of other PPV23 studies&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> Due to its broad valence of serotypes&#44; this polysaccharide vaccine continues to play an important role in protecting against IPD and pneumococcal pneumonia in the elderly despite its inherent immunological limitation&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> In Brazil&#44; sequential vaccination with PCV13 followed by PPV23 or PPV23 is only essentially recommended by the SUS to patients with some high-risk conditions and the elderly&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0038" class="elsevierStylePara elsevierViewall">This study has some limitations&#44; which are mostly related to its retrospective design&#46; We used laboratory data coupled with data extracted from medical records&#44; which led to a relatively high proportion of missing and possibly inaccurate values in some key variables&#46; Moreover&#44; the pattern of missing data may not have been completely at random&#44; leading to the possibility of some patients with poor outcomes&#44; as death soon after hospital admission&#44; having less data on comorbidity status&#44; for example&#46; Furthermore&#44; statistical comparisons were difficult as some of our stratifications contained many categories&#44; such as large number of serotypes&#44; despite the study having a fair number of cases&#46; It is difficult to find in the literature a study with our number of cases that matched laboratory and clinical data&#46; Another important limitation was the lack of data on the vaccination of our patients since data was not collected in a standardized way in medical records&#46; Our results may not be generalizable to the total number of hospitals in the metropolitan region of S&#227;o Paulo and even less in Brazil&#44; as the data were collected from public and philanthropic teaching hospitals&#44; which usually have a more severe patient profile and can be accompanied by chronic diseases in these services&#46;</p><p id="para0039" class="elsevierStylePara elsevierViewall">In conclusion&#44; this study highlights the importance of vaccines with higher valence of serotypes in the vaccination program in Brazil&#44; which offer substantial benefit to prevent IPD in vulnerable people mainly those with underlying comorbidity and the elderly subject to high morbimortality from IPD&#46;</p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Disclaimer</span><p id="para0041" class="elsevierStylePara elsevierViewall">All authors have approved the final version of the manuscript&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Author&#39;s contributions</span><p id="para0042" class="elsevierStylePara elsevierViewall">Conceived and designed the study&#58; RAK&#44; MCCB&#44; JCM&#59; statistical analysis&#58; ALB&#44; JCM&#59; Acquisition of medical data&#58; RR&#44; MAPS&#44; AEG&#44; FR&#44; TG&#59; laboratory data&#58; MCCB&#59; revision of the manuscript&#58; RAK&#44; MCCB&#44; JCM&#44; ALB&#46;</p></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Funding</span><p id="para0043" class="elsevierStylePara elsevierViewall">This study was supported by Pfizer&#44; Inc&#46;&#44; USA&#44; by Adolfo Lutz Institute&#44; Secretary of Health of the State of S&#227;o Paulo&#44; and the National Council for Scientific and Technological Development&#47;CNPq through grants to M&#46;C&#46;C Brandileone &#40;Grant No&#46; 302338&#47;2018-7&#41;&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "titulo" => "Material and methods"
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    "fechaRecibido" => "2022-10-09"
    "fechaAceptado" => "2023-01-13"
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          "clase" => "keyword"
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            0 => "Invasive pneumococcal diseases"
            1 => "Comorbidity"
            2 => "Chronic diseases"
            3 => "Antimicrobial resistance"
            4 => "Pneumococcal serotypes"
            5 => "Pneumococcal vaccine"
            6 => "Pneumococcal conjugate vaccine"
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    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Background</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">Chronic conditions increase the risk of invasive pneumococcal diseases &#40;IPD&#41;&#46; Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations&#46; In Brazil&#44; pneumococcal vaccines are included in the National Immunization Program &#40;PNI&#41;&#58; PCV10 for &#60; 2 years-old&#44; and PPV23 for high risk-patients aged &#8805; 2 years and institutionalized &#8805; 60 years&#46; PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Methods</span><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus&#46; Vaccine-serotype-coverage was estimated&#46; Patients were classified according to presence of comorbidities&#58; healthy&#44; without comorbidities&#59; at-risk&#44; included immunocompetent persons with specific medical conditions&#59; high-risk&#44; with immunocompromising conditions and others</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara012" class="elsevierStyleSimplePara elsevierViewall">406 IPD cases were evaluated&#46; Among 324 cases with information on medical conditions&#44; children &#60; 5 years were mostly healthy &#40;55&#46;9&#37;&#41;&#44; while presence of comorbidity prevailed in adults &#8805; 18 years old &#40;&#62; 82&#46;0&#37;&#41;&#46; Presence of &#8805;1 risk condition was reported in &#8805; 34&#46;8&#37; of adults&#46; High-risk conditions were more frequent than at-risk in all age groups&#46; Among high-risk comorbidity &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;211&#41;&#44; cancer &#40;28&#37;&#41;&#44; HIV&#47;AIDS &#40;25&#46;7&#37;&#41; and hematological diseases &#40;24&#46;5&#37;&#41; were the most frequent&#46; Among at-risk conditions &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;89&#41;&#44; asthma &#40;16&#46;5&#37;&#41; and diabetes &#40;8&#46;1&#37;&#41; were the most frequent&#46; Among 404 isolates&#44; 42&#46;9&#37; belonged to five serotypes&#58; 19A &#40;14&#46;1&#37;&#41;&#44; 3 &#40;8&#46;7&#37;&#41;&#44; 6C &#40;7&#46;7&#37;&#41;&#44; 4 and 8 &#40;6&#46;2&#37; each&#41;&#59; 19A and 6C expressed antimicrobial-non-susceptibility&#46; The vaccine-serotype-coverage was&#58; PCV10&#44; 19&#46;1&#37;&#44; PCV13&#44; 43&#46;8&#37;&#59; PCV15&#44; 47&#46;8&#37;&#59; PCV20&#44; 62&#46;9&#37;&#59; PCV21&#44; 65&#46;8&#37;&#44; and PPV23&#44; 67&#46;3&#37;&#46; Information on hospital outcome was available for 283 patients&#44; of which 28&#46;6&#37; died&#46; Mortality was 54&#46;2&#37; for those with meningitis&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusion</span><p id="spara013" class="elsevierStyleSimplePara elsevierViewall">Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD&#46; The present data contribute to pneumococcal vaccination public health policies for vulnerable patients&#44; mainly those with comorbidity and the elderly&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="notep0001">S&#227;o Paulo Study Group for IPD&#58; S&#46;C&#46;G&#46; Almeida<span class="elsevierStyleSup">b</span>&#44; C&#46;R&#46;M&#46; Yoshioka<span class="elsevierStyleSup">e</span>&#44; Microbiology Laboratory team &#40;LIM 03&#41;&#44; A&#46;I&#46; Paula<span class="elsevierStyleSup">g</span>&#44; N&#46; Hosino<span class="elsevierStyleSup">g</span>&#44; A&#46; Yamaguti<span class="elsevierStyleSup">g</span>&#44; J&#46;S&#46; Mendon&#231;a<span class="elsevierStyleSup">g</span>&#46;</p>"
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          "leyenda" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Only patients with high- and at-risk profiles were included in the denominators of these proportions&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0002"></a><th class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_colgroup " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age group &#40;years&#41;</th></tr><tr title="table-row"><a name="en0003"></a><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0004"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&#60; 5 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0005"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">5 - 17 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0006"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">18 &#8211; 49 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0007"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">50 &#8211; 64 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0008"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&#8805; 65 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0009"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><a name="en0010"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0011"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0012"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0013"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0014"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0015"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0016"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0017"></a><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="7" align="left" valign="top">Comorbidity status</td></tr><tr title="table-row"><a name="en0018"></a><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>High risk&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9 &#40;26&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">11 &#40;84&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">72 &#40;64&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">65 &#40;74&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">44 &#40;57&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">201 &#40;62&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>At risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 &#40;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">20 &#40;17&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">11 &#40;12&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">21 &#40;27&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">60 &#40;18&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0032"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Healthy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">19 &#40;55&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">20 &#40;17&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">11 &#40;12&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">12 &#40;15&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">63 &#40;19&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0039"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="7" align="left" valign="top">Number of comorbidities&#42;</td></tr><tr title="table-row"><a name="en0040"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">13 &#40;86&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8 &#40;61&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">60 &#40;65&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">40 &#40;52&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">41 &#40;63&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">162 &#40;62&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0047"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5 &#40;38&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">32 &#40;34&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">36 &#40;47&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">24 &#40;36&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">99 &#40;37&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0054"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0057"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">324&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Risk profile of hospitalized patients with invasive pneumococcal disease &#40;IPD&#41; with information on medical conditions&#44; by age group&#46; Brazil&#44; 2016-2018&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0002"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0002"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">Only for patients with information on diagnosis&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0061"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0062"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome status</th><a name="en0063"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">p-value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\t\t</th><a name="en0065"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">Cure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0066"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">Death&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><a name="en0068"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0069"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0070"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0071"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0072"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="4" align="left" valign="top">Age group</td></tr><tr title="table-row"><a name="en0073"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 5 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;89&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;10&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0077"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>5-17 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;88&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0081"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>18-49 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;82&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;17&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0085"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>50-64 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;61&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;38&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0089"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805; 65 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;57&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0091"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;42&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0093"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>IPD diagnosis&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;45&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0095"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;54&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0097"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="4" align="left" valign="top">Meningitis</td></tr><tr title="table-row"><a name="en0098"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0099"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">145 &#40;73&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;26&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0102"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0103"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;74&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;25&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0106"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="4" align="left" valign="top">Comorbidity status<a class="elsevierStyleCrossRef" href="#tb2fn1"><span class="elsevierStyleSup">&#8270;&#8270;</span></a></td></tr><tr title="table-row"><a name="en0107"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>High risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113 &#40;72&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;27&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;410&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0111"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>At risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0115"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Healthy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;78&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;21&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0119"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="4" align="left" valign="top">Number of comorbidities<a class="elsevierStyleCrossRef" href="#tb2fn2"><span class="elsevierStyleSup">&#8270;&#8270;&#8270;</span></a></td></tr><tr title="table-row"><a name="en0120"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0121"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94 &#40;72&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;27&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0123"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;750&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0124"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;69&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0126"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;30&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0127"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0128"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">202 &#40;71&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;28&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0131"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tb2fn1"
              "etiqueta" => "&#8270;&#8270;"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0003">Only for patients with information on medical conditions&#46;</p>"
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            1 => array:3 [
              "identificador" => "tb2fn2"
              "etiqueta" => "&#8270;&#8270;&#8270;"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0004">Only for patients with high- and at-risk profiles&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Demographic and clinical characteristics of hospitalized patients with invasive pneumococcal diseases &#40;IPD&#41; with information on outcome who were not transferred out&#44; by outcome status&#46; Brazil&#44; 2016-2018&#46;</p>"
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      2 => array:8 [
        "identificador" => "tbl0003"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0003"
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            "rol" => "short"
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          "leyenda" => "<p id="spara006" class="elsevierStyleSimplePara elsevierViewall">1NT&#44; non-typeable&#59; among 406 cases&#44; serotype data for 2 isolates were missing&#46;</p>"
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            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0132"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0133"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="12" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age group &#40;years&#41;</th></tr><tr title="table-row"><a name="en0134"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">Serotype&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0135"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#60;5 y</th><a name="en0136"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">5-17 y</th><a name="en0137"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">18-49 y</th><a name="en0138"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">50-64 y</th><a name="en0139"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#8805;65 y</th><a name="en0140"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total</th></tr><tr title="table-row"><a name="en0141"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0142"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0143"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0144"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0145"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0146"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0147"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0148"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0149"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0150"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0151"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0152"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0153"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0154"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">19A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0155"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0156"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">37&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0157"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0158"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0159"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0160"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">11&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0161"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0162"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0163"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0164"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0165"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0166"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">14&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0167"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0168"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0169"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0170"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0171"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0172"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0173"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0174"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0175"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">12&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0176"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0177"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">12&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0178"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0179"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0180"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">6C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0181"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0182"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0183"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">23B&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0723"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0724"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0725"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0726"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0727"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0728"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">100&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0729"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0730"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0731"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0732"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">100&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0733"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0734"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">100&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0735"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0736"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">100&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0737"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">404&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0738"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">100&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara005" class="elsevierStyleSimplePara elsevierViewall">Distribution of serotypes of invasive pneumococcal isolates&#44; by age group&#46; Brazil&#44; 2016-2018&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0004"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0004"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spara008" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#8364;</span>Non-susceptible&#58; intermediate plus resistant criteria according to CLSI&#44; 2020&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0739"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Antimicrobial &#40;N tested&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0740"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Non-susceptible N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0741"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Penicillin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0742"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0743"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>meningitis &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0744"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;20&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0745"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>non-meningitis &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;376&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0746"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0747"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Ceftriaxone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0748"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0749"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>meningitis &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0750"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0751"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>non-meningitis &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;376&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0752"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0753"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Erythromycin &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;404&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0754"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108 &#40;26&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0755"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Clindamycin &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;394&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0756"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83 &#40;21&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0757"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Sulfamethoxazole-trimethoprim &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;404&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0758"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">134 &#40;33&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0759"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Levofloxacin &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;378&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0760"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0761"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Tetracycline &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;379&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0762"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">178 &#40;46&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0763"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Vancomycin &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;405&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0764"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0765"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Multidrug resistance<a class="elsevierStyleCrossRef" href="#tb4fn2"><span class="elsevierStyleSup">&#35;</span></a> &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;406&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0766"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;13&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tb4fn2"
              "etiqueta" => "&#35;"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0007">Multidrug resistance&#58; non-susceptibility to at least three antimicrobial classes&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara007" class="elsevierStyleSimplePara elsevierViewall">Antimicrobial non-susceptibility of pneumococcal invasive isolates&#46; Brazil&#44; 2016-2018&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0005"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0767"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0768"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="12" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Pneumococcal vaccine</th></tr><tr title="table-row"><a name="en0769"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0770"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PCV10</th><a name="en0771"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PC V13</th><a name="en0772"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PC V15</th><a name="en0773"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PC V20</th><a name="en0774"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PCV21</th><a name="en0775"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PPV23</th></tr><tr title="table-row"><a name="en0776"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0777"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0778"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0779"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0780"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0781"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0782"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0783"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0784"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0785"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0786"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0787"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0788"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0789"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="13" align="left" valign="top">Age group &#40;years&#41;</td></tr><tr title="table-row"><a name="en0790"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;5 y &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0791"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0792"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0793"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0794"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">47&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0795"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0796"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">56&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0797"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0798"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">72&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0799"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0800"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0801"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0802"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">70&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0803"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>5-17 y &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0804"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0805"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0806"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0807"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0808"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0809"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0810"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0811"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0812"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0813"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0814"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0815"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0816"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>18-49 y &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;127&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0817"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0818"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">31&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0819"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0820"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">49&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0821"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0822"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">52&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0823"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0824"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">65&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0825"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0826"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">52&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0827"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0828"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">70&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0829"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>50-64 y &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;103&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0830"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0831"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">16&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0832"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0833"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">38&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0834"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0835"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">41&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0836"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0837"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">60&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0838"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0839"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">70&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0840"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0841"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">68&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0842"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805; 65 y &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;106&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0843"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0844"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">16&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0845"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0846"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">38&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0847"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0848"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">43&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0849"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0850"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">58&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0851"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0852"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">64&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0853"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0854"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">61&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0855"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>All ages &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;404&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0856"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0857"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">19&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0858"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">177&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0859"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">43&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0860"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">193&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0861"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">47&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0862"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">254&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0863"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">62&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0864"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">266&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0865"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">65&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0866"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">272&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0867"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">67&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0868"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="13" align="left" valign="top">Risk group for IPD</td></tr><tr title="table-row"><a name="en0869"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Healthy &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;63&#41;<a class="elsevierStyleCrossRef" href="#tb5fn1"><span class="elsevierStyleSup">&#163;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0870"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0871"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">26&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0872"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0873"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0874"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0875"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">50&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0876"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0877"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">71&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0878"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0879"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">65&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0880"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0881"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0882"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Any comorbidity &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;261&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0883"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0884"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">18&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0885"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0886"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0887"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0888"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">45&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0889"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0890"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">59&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0891"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">167&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0892"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0893"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0894"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">65&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0895"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>High-risk &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;211&#41;<a class="elsevierStyleCrossRef" href="#tb5fn2"><span class="elsevierStyleSup">&#167;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0896"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0897"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">19&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0898"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0899"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">43&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0900"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0901"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0902"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0903"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">58&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0904"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">131&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0905"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">62&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0906"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0907"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">63&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0908"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="13" align="left" valign="top">Antimicrobial non-susceptibility<a class="elsevierStyleCrossRef" href="#tb5fn3"><span class="elsevierStyleSup">&#8364;</span></a></td></tr><tr title="table-row"><a name="en0909"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>PEN &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0910"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0911"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0912"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0913"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">79&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0914"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0915"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">79&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0916"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0917"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">79&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0918"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0919"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">83&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0920"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0921"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">70&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0922"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>CRO &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0923"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0924"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0925"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0926"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0927"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0928"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0929"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0930"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0931"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0932"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0933"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0934"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0935"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>TET &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;178&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0936"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0937"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">12&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0938"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0939"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">41&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0940"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0941"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">44&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0942"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0943"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">58&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0944"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0945"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">71&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0946"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0947"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">69&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0948"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>STX &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;134&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0949"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0950"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">20&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0951"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0952"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">55&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0953"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0954"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">56&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0955"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0956"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">64&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0957"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0958"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">61&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0959"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0960"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">67&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0961"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>ERY &#40;<span class="elsevierStyleItalic">n&#160;&#61;</span>&#160;108&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0962"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0963"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">10&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0964"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0965"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">53&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0966"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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