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November 1986

Risk Factors for Acquiring Pneumococcal Infections

Author Affiliations

From the Departments of Medicine (Drs Lipsky and Inui) and Epidemiology (Dr Koepsell), and the Robert Wood Johnson Clinical Scholars Program (Drs Boyko and Inui), University of Washington School of Medicine, and the Medical Service (Drs Lipsky and Inui), Seattle Veterans Administration Medical Center, Seattle.

Arch Intern Med. 1986;146(11):2179-2185. doi:10.1001/archinte.1986.00360230105016

• To identify risk factors for developing pneumococcal infections, we carried out a case-controlled study on a retrospectively constituted cohort of 3074 clinic patients in a presumed high-risk population. Culture-proved pneumococcal infections were identified in 63 men over a period of 5.5 years, yielding an estimated incidence of 6.3 cases per 1000 person-years. By comparing these patients with 130 uninfected control patients, the relative risk of pneumococcal infections related to various exposures was calculated by logistic regression analysis. Statistically significant independent risk factors (and their relative risks) were as follows: dementia (5.82), seizure disorders (4.38), current cigarette smoking (4.00), congestive heart failure (3.83), cerebrovascular disease (3.82), institutionalization (3.13), and chronic obstructive pulmonary disease (2.38). Risk was increased with age and previous hospitalizations, and, to a nonsignificant degree, by hotel residence (3.93), lung cancer (2.24), previous smoking (2.14), corticosteroid use (1.81), and alcoholism (1.35); but not by diabetes mellitus (0.99), nonlung malignancies (0.93), nonwhite race (0.89), or ischemic heart disease (0.58).

(Arch Intern Med 1986;146:2179-2185)

Broome CV, Facklam RR:  Epidemiology of clinically significant isolates of Streptococcus pneumoniae in the United States.  Rev Infect Dis 1981;3:277-280.Crossref
Recommendations of the Immunization Practices Advisory Committee:  Update: Pneumococcal polysaccharide vaccine usage—United States.  MMWR 1984;33:273-281.
Hirschmann JV, Lipsky BA:  Pneumococcal vaccine in the United States: A critical analysis.  JAMA 1981;246:1428-1432.Crossref
Finland M:  Pneumococcal infections , in Evans AS, Feldman HA (eds):  Bacterial Infections of Humans: Epidemiology and Control . New York, Plenum Press, 1982, pp 417-433.
Schwartz JS:  Pneumococcal vaccine: Clinical efficacy and effectiveness.  Ann Intern Med 1982;96:208-220.Crossref
 Indications for pneumococcal vaccine, editorial.  Lancet 1981;1:251-253.
Filice GA, Darby CP, Fraser DW:  Pneumococcal bacteremia in Charleston County, South Carolina.  Am J Epidemiol 1980;112:828-835.
Mufson MA:  Pneumococcal disease in a medium-sized community in the United States.  JAMA 1982;248:1486-1489.Crossref
Oseasohn R, Skipper BE, Tempest B:  Pneumonia in a Navajo community: A two-year experience.  Am Rev Respir Dis 1978;117:1003-1009.
Valenti WM, Jenzer M, Bentley DW:  Type-specific pneumococcal respiratory disease in the elderly and chronically ill.  Am Rev Respir Dis 1978;117:233-238.
Austrian R:  Some observations on the pneumococcus and on the current status of pneumococcal disease and its prevention.  Rev Infect Dis 1981;3( (suppl) ):S1-S17.Crossref
Heffron R:  Pneumonia: With Special Reference to Pneumococcus Lobar Pneumonia . New York, Commonwealth Fund, 1939, pp 242-299.
Foy HM, Wentworth B, Kenny GE, et al:  Pneumococcal isolations from patients with pneumonia and control subjects in a prepaid medical care group.  Am Rev Respir Dis 1975;111:595-603.
Mufson MA:  Pneumococcal infections.  JAMA 1981;246:1942-1948.Crossref
Dennehy PH, Faich GA:  Pneumococcal pneumonia in Rhode Island: Implications for vaccine use.  J Infect 1982;4:229-235.Crossref
Henneberger PK, Galaid EI, Marr JS:  The descriptive epidemiology of pneumococcal meningitis in New York City.  Am J Epidemiol 1983;117: 484-491.
Van Metre TE Jr:  Pneumococcal pneumonia treated with antibiotics: The prognostic significance of certain clinical findings.  N Engl J Med 1954;251:1048-1052.Crossref
Austrian R, Gold J:  Pneumococcal bacteremia with especial reference to bacteremic pneumococcal pneumonia.  Ann Intern Med 1964;60:759-776.Crossref
Mufson MA, Kruss DM, Wasil RE, et al:  Capsular types and outcome of bacteremic pneumococcal disease in the antibiotic era.  Arch Intern Med 1974;134:505-510.Crossref
Sullivan RJ Jr, Dowdle WR, Marine WM, et al:  Adult pneumonia in a general hospital.  Arch Intern Med 1972;129:935-942.Crossref
Weisholtz SJ, Hartman BJ, Roberts RB:  Effect of underlying disease and age on pneumococcal serotype distribution.  Am J Med 1983;75:199-205.Crossref
Lamothe F, Delage G, Laverdiére M, et al:  Serogroups and serotypes of pneumococci in Montreal: Correlations with age, outcome and indications for vaccination.  Can Med Assoc J 1984;130:737-740.
Ruben FL, Norden CW, Korica Y:  Pneumococcal bacteremia at a medical/surgical hospital for adults between 1975 and 1980.  Am J Med 1984;77:1091-1094.Crossref
Gruer LD, McKendrick MW, Geddes AM:  Pneumococcal bacteremia: A continuing challenge.  Q J Med 1984;53:259-270.
Fekety FR Jr, Caldwell J, Gump D, et al:  Bacteremia, viruses, and mycoplasmas in acute pneumonia in adults.  Am Rev Respir Dis 1971;104: 499-507.
Norrby SR, Pope KA:  Pneumococcal pneumonia.  J Infect 1979;1: 109-120.Crossref
Riley ID, Douglas RM:  An epidemiologic approach to pneumococcal disease.  Rev Infect Dis 1981;3:233-244.Crossref
Fedson DS, Baldwin JA:  Previous hospital care as a risk factor for pneumonia: Implications for immunization with pneumococcal vaccine.  JAMA 1982;248:1989-1995.Crossref
Facklam RR:  Streptococci and aerococci , in Lennette EH, Balows A, Hausler WJ Jr, et al (eds):  Manual of Clinical Microbiology , ed 3. Washington, DC, American Society of Microbiology, 1980, pp 355-359.
Kleinbaum DG, Kupper LL, Morgenstern H:  Epidemiologic Research: Principles and Quantitative Methods . Belmont, Calif, Lifetime Learning Publications, 1982, pp 147-149, 419-491.
Rothman KJ, Boice JD:  Epidemiologic analysis with a programmable calculator . US Dept of Health, Education, and Welfare Publication No. (NIH) 79-1649. Government Printing Office, 1979.
Patrick KM, Woolley FR:  A cost-benefit analysis of immunization for pneumococcal pneumonia.  JAMA 1981;245:473-477.Crossref
Willems JS, Sanders CR, Riddiough MA, et al:  Cost effectiveness of vaccination against pneumococcal pneumonia.  N Engl J Med 1980;303: 553-559.Crossref
Austrian R:  Surveillance of Pneumococcal Infection for Field Trials of Polyvalent Pneumococcal Vaccines , report DAB-VDP-12-84. Bethesda, Md, National Institutes of Health, 1980, pp 1-84.
Riley ID, Andrews M, Howard R, et al:  Immunization with a polyvalent pneumococcal vaccine: Reduction of adult respiratory mortality in a New Guinea highlands community.  Lancet 1977;1:1338-1341.Crossref
Austrian R, Douglas RM, Schiffman G, et al:  Prevention of pneumococcal pneumonia by vaccination.  Trans Assoc Am Phys 1976;89:189-194.
Fraser DW, Broome C:  Pneumococcal vaccine: To use or not.  JAMA 1981;245:498-499.Crossref
Sachs FL:  Chronic bronchitis , in Pennington JE (ed):  Respiratory Infections: Diagnosis and Management . New York, Raven Press, 1983, pp 117-118.
Zavalla DC:  The threat of aspiration pneumonia in the aged.  Geriatrics 1977;32:46-51.
Evans AS, Jeffrey C, Niederman JC:  Cigarette smoking and acute noninfluenzal respiratory disease in military cadets.  Am J Epidemiol 1971;93:463-471.
Karh JD, Lebrush M, Rannon L:  Cigarette smoking as a risk factor for epidemic A(H1N1) influenza in young men.  N Engl J Med 1982;307:1042-1076.Crossref
Raman AS, Swinburne AJ, Fedullo AJ:  Pneumococcal adherence to the buccal epithelial cells of cigarette smokers.  Chest 1983;83:23-27.Crossref
Meyer RD:  Legionella infections: A review of five years of research.  Rev Infect Dis 1983;5:258-277.Crossref
Warner A:  State of the art: Clinical aspects of mucociliary transport.  Am Rev Respir Dis 1977;116:73-125.
Warr GA, Martin RR:  In vitro migration of human alveolar macrophages: Effects of cigarette smoking.  Infect Immun 1973;8:222-227.
Ferson M, Edwards A, Lind A, et al:  Low natural killer cell activity and immunoglobulin levels associated with smoking in human subjects.  Int J Cancer 1979;23:603-609.Crossref
Fedson DS, Chiarello LA:  Previous hospital care and pneumococcal bacteremia: Importance for pneumococcal immunization.  Arch Intern Med 1983;143:885-889.Crossref
Magnussen CR, Valenti WM, Mushlin AI: Potential efficacy of a pneumococcal vaccination program directed at inpatients, abstract 619. Proceedings of the 23rd Interscience Conference on Antimicrobial Agents and Chemotherapy, Las Vegas, Oct 24-26, 1983.
Klein RS, Adachi N:  Pneumococcal vaccine in the hospital: Improved use and implications for high-risk patients.  Arch Intern Med 1983;143: 1878-1881.Crossref
Kaufman P:  Pneumonia in old age.  Arch Intern Med 1947;79:518-531.Crossref
MacLeod CM, Hodges RG, Heidelberger M, et al:  Prevention of pneumococcal pneumonia by immunization with specific capsular polysaccharides.  J Exp Med 1945;82:445-465.Crossref
Ekwurtzel GM, Simmons JS, Dublin LI, et al:  Studies on immunizing substances in pneumococci: VIII. Report on field tests to determine the prophylactic value of pneumococcus antigen.  Public Health Rep 1938;53: 1877-1893.Crossref
De Maria A Jr, Browne K, Berk SL, et al:  An outbreak of type I pneumococcal pneumonia in a men's shelter.  JAMA 1980;244:1446-1450.Crossref
Smillie WG, Warnock GH, White HJ:  A study of a type I pneumococcus epidemic at the State Hospital in Worchester, Mass.  Am J Public Health 1938;24:522-535.
Smillie WG:  A study of an outbreak of type II pneumococcus pneumonia in the Veterans Administration Hospital at Bedford, Mass.  Am J Hyg 1936;24:522-523.
Johnston RB Jr:  The host response to invasion by Streptococcus pneumoniae: Protection and the pathogenesis of tissue damage.  Rev Infect Dis 1981;3:282-288.Crossref
Winterbauer RH, Bedon GA, Ball WC:  Recurrent pneumonia: Predisposing illness and clinical patterns in 158 patients.  Ann Intern Med 1969;70:689-700.Crossref
Brayton RG, Stokes PE, Schwartz MS, et al:  Effect of alcohol and various diseases on leukocyte mobilization, phagocytosis, and intracellular bacterial killing.  N Engl J Med 1970;282:123-128.Crossref
Adams HG, Jordan C:  Infections in the alcoholic.  Med Clin North Am 1984;68:179-200.
Moss JM:  Pneumococcus infection in diabetes mellitus: Is this justification for immunization?  JAMA 1980;243:2301-2303.Crossref
Patriarcha PA, Schlech WF III, Ninman AR, et al:  Pneumococcal vaccination practices among private physicians.  Pub Health Rep 1982;97: 406-408.