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Opportunities for Prevention in the Conjugate Vaccine Era

Katherine A. Robinson, MPH; Wendy Baughman, MSPH; Gretchen Rothrock, MPH; Nancy L. Barrett, MS, MPH; Margaret Pass, MS, CIC; Catherine Lexau, MPH; Barbara Damaske; Karen Stefonek, MPH; Brenda Barnes, RN; Jan Patterson, MD; Elizabeth R. Zell, MStat; Anne Schuchat, MD; Cynthia G. Whitney, MD, MPH; for the Active Bacterial Core Surveillance (ABCs)/Emerging Infections Program Network

JAMA. 2001;285:1729-1735.

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.

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).

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