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Michael Davidson, MD, MPH; Cynthia D. Schraer, MD; Alan J. Parkinson, PhD; John F. Campbell, MD; Richard R. Facklam, PhD; Robert B. Wainwright, MD, DTM&H; Anne P. Lanier, MD, MPH; William L. Heyward, MD, MPH

JAMA. 1989;261(5):715-718.

Abstract
From 1980 through 1986, one hundred fourteen Alaska Native patients from the Yukon-Kuskokwim Delta had community-acquired invasive pneumococcal disease confirmed by isolates of Streptococcus pneumoniae from normally sterile body sites. The annual bacteremia rates per 100 000 persons were 105 cases for all ages, 1195 cases for infants under 2 years of age, and 130 cases for adults over 59 years of age. These were six to 34 times higher than rates reported for other US populations. The most common underlying conditions in infants diagnosed before 24 months of age were previously diagnosed anemia and pneumonia, while alcoholism and anemia were most common in adults. The case-fatality rate for infants under 2 years of age was 3.2%, and the case-fatality rate for adults over 59 years of age was 30%. Serotyping of more than half the isolates identified 96% of these isolates to be present in the currently available pneumococcal polysaccharide vaccine. The pneumococcal disease rates reported herein are likely to be underestimates since most diseases that occur in this region are treated at the village level without laboratory confirmation.

(JAMA 1989;261:715-718)

Author Affiliations
From the Arctic Investigations Laboratory, Anchorage, Alaska (Drs Davidson, Parkinson, Wainwright, Lanier, and Heyward); the Division of Bacterial Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta (Drs Campbell and Facklam); and the Alaska Area Native Health Service, Public Health Service, Anchorage (Dr Schraer).

Footnotes
The opinions expressed in this article are those of the authors and do not necessarily reflect the views of the Indian Health Service.

Reprint requests to the Arctic Investigations Laboratory, Centers for Disease Control, 225 Eagle St, Anchorage, AK 99501 (Dr Davidson).

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