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http://content.nejm.org/cgi/content/abstract/348/18/1737
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Decline in Invasive
Pneumococcal Disease after the Introduction of Protein–Polysaccharide Conjugate
Vaccine
Cynthia G. Whitney, M.D., M.P.H., Monica M. Farley, M.D., James Hadler, M.D., M.P.H., Lee H. Harrison, M.D., Nancy M. Bennett, M.D., Ruth Lynfield, M.D., Arthur Reingold, M.D., Paul R. Cieslak, M.D., Tamara Pilishvili, M.P.H., Delois Jackson, M.S.A., Richard R. Facklam, Ph.D., James H. Jorgensen, Ph.D., Anne Schuchat, M.D., for the Active Bacterial Core Surveillance of the Emerging Infections Program Network
ABSTRACT
Background In early 2000, a protein–polysaccharide conjugate vaccine targeting seven pneumococcal serotypes was licensed in the United States for use in young children.
Methods We examined population-based data from the Active Bacterial Core Surveillance of the Centers for Disease Control and Prevention to evaluate changes in the burden of invasive disease, defined by isolation of Streptococcus pneumoniae from a normally sterile site. Serotyping and susceptibility testing of isolates were performed. We assessed trends using data from seven geographic areas with continuous participation from 1998 through 2001 (population, 16 million).
Results The rate of invasive disease dropped from an average of 24.3 cases per 100,000 persons in 1998 and 1999 to 17.3 per 100,000 in 2001. The largest decline was in children under two years of age. In this group, the rate of disease was 69 percent lower in 2001 than the base-line rate (59.0 cases per 100,000 vs. 188.0 per 100,000, P<0.001); the rate of disease caused by vaccine and vaccine-related serotypes declined by 78 percent (P<0.001) and 50 percent (P<0.001), respectively. Disease rates also fell for adults; as compared with base line, the rate of disease in 2001 was 32 percent lower for adults 20 to 39 years of age (7.6 cases per 100,000 vs. 11.2 per 100,000, P<0.001), 8 percent lower for those 40 to 64 years of age (19.7 per 100,000 vs. 21.5 per 100,000, P=0.03), and 18 percent lower for those 65 years of age or more (49.5 per 100,000 vs. 60.1 per 100,000, P<0.001). The rate of disease caused by strains that were not susceptible to penicillin was 35 percent lower in 2001 than in 1999 (4.1 cases per 100,000 vs. 6.3 per 100,000, P<0.001).
Conclusions The use of the pneumococcal conjugate vaccine is preventing disease in young children, for whom the vaccine is indicated, and may be reducing the rate of disease in adults. The vaccine provides an effective new tool for reducing disease caused by drug-resistant strains.
Source Information
From the Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta (C.G.W., T.P., D.J., R.R.F., A.S.); Emory University School of Medicine and the Veterans Affairs Medical Center, Atlanta (M.M.F.); the Connecticut Department of Public Health, Hartford (J.H.); Johns Hopkins University Bloomberg School of Public Health, Baltimore (L.H.H.); the Monroe County Department of Health and the University of Rochester, Rochester, N.Y. (N.M.B.); the Minnesota Department of Health, Minneapolis (R.L.); the School of Public Health, University of California, Berkeley (A.R.); the Oregon Department of Human Services, Health Division, Portland (P.R.C.); and the University of Texas Health Science Center, San Antonio (J.H.J.).
Address reprint requests to Dr. Whitney at CDC Mailstop C-23, 1600 Clifton Rd. NE, Atlanta, GA 30333, or at cwhitney@cdc.gov.
This article has been cited by other articles:
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