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Lexau CA, Lynfield R, Danila R, et al. Changing Epidemiology of Invasive Pneumococcal Disease Among Older
Adults in the Era of Pediatric Pneumococcal Conjugate Vaccine. JAMA. 2005;294(16):2043–2051. doi:10.1001/jama.294.16.2043
Author Affiliations: Minnesota Department of
Health, Minneapolis (Drs Lexau, Lynfield, and Danila); Division of Bacterial
and Mycotic Diseases, National Center for Infectious Diseases, Centers for
Disease Control and Prevention, Atlanta, Ga (Drs Facklam and Whitney and Ms
Pilishvili); Emory University School of Medicine and the Atlanta Veterans
Affairs Medical Center, Decatur, Ga (Dr Farley); Department of International
Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore,
Md (Dr Harrison); Department of Preventive Medicine, Vanderbilt University
School of Medicine, Nashville, Tenn (Dr Schaffner); School of Public Health,
University of California, Berkeley (Dr Reingold); Monroe County Health Department,
Rochester, NY (Dr Bennett); Connecticut Department of Public Health, Epidemiology
Program, Hartford (Dr Hadler); Department of Human Services, Office of Disease
Prevention and Epidemiology, Portland, Ore (Dr Cieslak).
Context A conjugate vaccine targeting 7 pneumococcal serotypes was licensed
for young children in 2000. In contrast to the 23-valent polysaccharide vaccine
used in adults, the 7-valent conjugate vaccine affects pneumococcal carriage
and transmission. Early after its introduction, incidence of invasive pneumococcal
disease declined among older adults, a group at high risk for pneumococcal
Objective To determine among adults aged 50 years or older whether incidence of
invasive pneumococcal disease, disease characteristics, or the spectrum of
patients acquiring these illnesses have changed over the 4 years since pneumococcal
conjugate vaccine licensure.
Design, Setting, and Population Population-based surveillance of invasive pneumococcal disease in 8
US geographic areas (total population, 18 813 000), 1998-2003.
Main Outcome Measures Incidence of invasive pneumococcal disease by pneumococcal serotype
and other characteristics; frequency among case patients of comorbid conditions
and other factors influencing mortality.
Results Incidence of invasive pneumococcal disease among adults aged 50 years
or older declined 28% (95% confidence interval [CI], −31% to −24%),
from 40.8 cases/100 000 in 1998-1999 to 29.4 in 2002-2003. Among those
aged 65 years or older, the 2002-2003 rate (41.7 cases/100 000) was lower
than the Healthy People 2010 goal (42 cases/100 000). Among adults aged
50 years or older, incidence of disease caused by the 7 conjugate vaccine
serotypes declined 55% (95% CI, −58% to −51%) from 22.4 to 10.2
cases/100 000. In contrast, disease caused by any of the 16 serotypes
only in polysaccharide vaccine did not change, and disease caused by serotypes
not in either vaccine increased somewhat, from 6.0 to 6.8 cases/100 000
(13%; 95% CI, 1% to 27%). Between 1998-1999 and 2002-2003, the proportion
of case-patients with human immunodeficiency virus infection increased from
1.7% (47/2737) to 5.6% (124/2231) (P<.001), and
those with any comorbid condition that is an indication for pneumococcal polysaccharide
vaccination increased from 62.3% (1842/2955) to 72.0% (1721/2390) (P<.001).
Conclusions Our findings indicate that use of conjugate vaccine in children has
substantially benefited older adults. However, persons with certain comorbid
conditions may benefit less than healthier persons from the indirect effects
of the new vaccine.
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