Journal Article

Invasive Pneumococcal Disease a Decade after Pneumococcal Conjugate Vaccine Use in an American Indian Population at High Risk for Disease

Robert Weatherholtz, Eugene V. Millar, Lawrence H. Moulton, Raymond Reid, Karen Rudolph, Mathuram Santosham and Katherine L. O'Brien

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 9, pages 1238-1246
Published in print May 2010 | ISSN: 1058-4838
Published online May 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/651680
Invasive Pneumococcal Disease a Decade after Pneumococcal Conjugate Vaccine Use in an American Indian Population at High Risk for Disease

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Background. Before 7-valent pneumococcal conjugate vaccine (PCV7) introduction, invasive pneumococcal disease (IPD) rates among Navajo were several-fold those of the general US population. Only 50% of IPD cases in children involved PCV7 serotypes.

Methods. We conducted active, population-based surveillance for IPD for the period 1995–2006. We documented case characteristics and serotyped the isolates.

Results. Over 12-year period, we identified 1508 IPD cases, 447 of which occurred in children aged <5 years. Rates of IPD due to vaccine serotypes among children aged <1 year, 1 to <2 years, and 2 to <5 years decreased from 210, 263, and 51 cases per 100,000 population, respectively in 1995–1997 to 0 cases in 2004–2006 (P < .001). Among adults aged ⩾65 years, rates of IPD due to vaccine serotypes decreased 81% (95% confidence interval, −98% to −9%; P = .02). Rates of nonvaccine serotype IPD were unchanged in all age strata except for persons aged 18 to <40 years, among whom the rate decreased by 35% from 27 to 18 cases per 100,000 population (95% confidence interval, −57% to −1%; P = 03).

Conclusions. Vaccine-serotype IPD has virtually been eliminated in the PCV7 era among Navajo of all ages. Overall rates of nonvaccine-serotype IPD have not increased, although increases have occurred for some individual types. Rates of all-serotype IPD among Navajo children remain 3–5-fold greater than in the general US population.

Journal Article.  4364 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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