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Robinson KA, Baughman W, Rothrock G, et al. Epidemiology of Invasive Streptococcus pneumoniae Infections in the United States, 1995-1998: Opportunities for Prevention in the Conjugate Vaccine Era. JAMA. 2001;285(13):1729–1735. doi:10.1001/jama.285.13.1729
Author Affiliations: Respiratory Diseases Branch (Ms Robinson and Drs Schuchat and Whitney) and Biostatistics and Information Management Branch (Ms Zell), Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, and the Emerging Infections Program, Georgia Department of Human Resources, and Emory University School of Medicine (Ms Baughman), Atlanta, Ga; Emerging Infections Program, California Department of Health Services, and University of California, Berkeley, School of Public Health, Berkeley (Ms Rothrock); Emerging Infections Program, Connecticut Department of Public Health, Hartford (Ms Barrett); Emerging Infections Program, Maryland Department of Health and Mental Hygiene, and Johns Hopkins University School of Public Health, Baltimore (Ms Pass); Emerging Infections Program, Minnesota Department of Health, Minneapolis (Ms Lexau); Emerging Infections Program, New York State Department of Health, Albany (Ms Damaske); Emerging Infections Program, Oregon Department of Human Resources Health Division, Portland (Ms Stefonek); Emerging Infections Program, Tennessee Department of Health and Vanderbilt University Medical Center, Knoxville (Ms Barnes); and the University of Texas Health Science Center, San Antonio (Dr Patterson).
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.
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