Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995-1998: Opportunities for prevention in the conjugate vaccine era.

CONTEXT Pneumococcal polysaccharide vaccine is recommended for elderly persons and adults with certain chronic illnesses. Additionally, a recently licensed pneumococcal 7-valent conjugate vaccine has been recommended for use in young children and could dramatically change the epidemiology of pneumococcal disease. OBJECTIVES To assess pneumococcal disease burden in the United States, estimate the potential impact of new vaccines, and identify gaps in vaccine recommendations. DESIGN AND SETTING Analysis of data from the Active Bacterial Core Surveillance (ABCs)/Emerging Infections Program Network, an active, population-based system in 9 states. PATIENTS A total of 15 860 cases of invasive pneumococcal disease occurring between January 1, 1995, and December 31, 1998. MAIN OUTCOME MEASURES Age- and race-specific pneumoccocal disease incidence rates per 100 000 persons, case-fatality rates, and vaccine preventability. RESULTS In 1998, overall incidence was 23.2 cases per 100 000, corresponding to an estimated 62 840 cases in the United States. Incidence was highest among children younger than 2 years (166.9) and adults aged 65 years or older (59.7). Incidence among blacks was 2.6 times higher than among whites (95% confidence interval [CI], 2.4-2.8). Overall, 28.6% of case-patients were at least 65 years old and 85.9% of cases in this age group were due to serotypes included in the 23-valent polysaccharide vaccine; 19.3% of case-patients were younger than 2 years and 82.2% of cases in this age group were due to serotypes included in the 7-valent conjugate vaccine. Among patients aged 2 to 64 years, 50.6% had a vaccine indication as defined by the Advisory Committee on Immunization Practices (ACIP). The case-fatality rate among patients aged 18 to 64 years with an ACIP indication was 12.1% compared with 5.4% for those without an indication (relative risk, 2.2; 95% CI, 1.7-2.9). CONCLUSIONS Young children, elderly persons, and black persons of all ages are disproportionately affected by invasive pneumococcal disease. Current ACIP recommendations do not address a subset of persons aged 18 to 64 years but do include those at highest risk for death from invasive pneumococcal disease.

[1]  B. Spratt,et al.  Prevention of pneumococcal disease by vaccination: does serotype replacement matter? , 2000, The Lancet.

[2]  E. Lewis,et al.  Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children , 2000, The Pediatric infectious disease journal.

[3]  Lisa B. Gelling,et al.  Epidemiologic Relation between HIV and Invasive Pneumococcal Disease in San Francisco County, California , 2000, Annals of Internal Medicine.

[4]  A. Schuchat,et al.  Invasive pneumococcal infection in Baltimore, Md: implications for immunization policy. , 2000, Archives of internal medicine.

[5]  M. Kolczak,et al.  Cigarette smoking and invasive pneumococcal disease. Active Bacterial Core Surveillance Team. , 2000, The New England journal of medicine.

[6]  S. Pelton.  Risk factors for invasive pneumococcal disease in children: a population-based case-control study in North America. , 2000, Pediatrics.

[7]  K. Nichol,et al.  The health and economic benefits associated with pneumococcal vaccination of elderly persons with chronic lung disease. , 1999, Archives of internal medicine.

[8]  L. Harrison,et al.  Risk factors for invasive pneumococcal disease in children: a population-based case-control study in North America. , 1999, Pediatrics.

[9]  R. Pinner,et al.  Progress toward eliminating Haemophilus influenzae type b disease among infants and children--United States, 1987-1997. , 1999, MMWR. Morbidity and mortality weekly report.

[10]  M. Cetron,et al.  Geocoding and linking data from population-based surveillance and the US Census to evaluate the impact of median household income on the epidemiology of invasive Streptococcus pneumoniae infections. , 1998, American journal of epidemiology.

[11]  N. Andrews,et al.  Invasive pneumococcal infection in South and West England , 1998, Epidemiology and Infection.

[12]  T. Murphy,et al.  Invasive pneumococcal disease in Dallas County, Texas: results from population-based surveillance in 1995. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[13]  A J Moskowitz,et al.  Cost-effectiveness of vaccination against pneumococcal bacteremia among elderly people. , 1997, JAMA.

[14]  A. Schuchat,et al.  Bacterial Meningitis in the United States in 1995 , 1997 .

[15]  M. Kolczak,et al.  Incidence of Community-Acquired Pneumonia Requiring Hospitalization Results of a Population-Based Active Surveillance Study in Ohio , 1997 .

[16]  R. Breiman,et al.  Prevention of pneumococcal disease : recommendations of the Advisory Committee on Immunization Practices (ACIP) , 1997 .

[17]  D. Greenberg,et al.  Epidemiology of invasive pneumococcal disease in southern California: implications for the design and conduct of a pneumococcal conjugate vaccine efficacy trial. , 1996, The Journal of infectious diseases.

[18]  M. Cetron,et al.  The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta. , 1995, The New England journal of medicine.

[19]  B. Gessner,et al.  Risk factors for invasive disease caused by Streptococcus pneumoniae among Alaska native children younger than two years of age. , 1995, The Pediatric infectious disease journal.

[20]  D. Parks,et al.  The epidemiology of invasive pneumococcal disease in Alaska, 1986-1990--ethnic differences and opportunities for prevention. , 1994, The Journal of infectious diseases.

[21]  R. Breiman,et al.  Pneumococcal polysaccharide vaccine efficacy. An evaluation of current recommendations. , 1993, JAMA.

[22]  M. Leinonen,et al.  Epidemiology of invasive pneumococcal infections in children in Finland. , 1992, JAMA.

[23]  M. Santosham,et al.  High incidence rates of invasive pneumococcal disease in the White Mountain Apache population. , 1992, Archives of internal medicine.

[24]  C. Bluestone,et al.  Ten‐year review of otitis media pathogens , 1992, The Pediatric infectious disease journal.

[25]  R. Adair,et al.  The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. , 1991, The New England journal of medicine.

[26]  A. Schuchat,et al.  Use of surveillance for invasive pneumococcal disease to estimate the size of the immunosuppressed HIV-infected population. , 1991, JAMA.

[27]  A. Hightower,et al.  Bacterial meningitis in the United States, 1986: report of a multistate surveillance study. The Bacterial Meningitis Study Group. , 1990, The Journal of infectious diseases.

[28]  R. Breiman,et al.  Pneumococcal bacteremia in Charleston County, South Carolina. A decade later. , 1990, Archives of internal medicine.