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High incidence rates of invasive pneumococcal disease in the White Mountain Apache population
M M Cortese1, M Wolff, J Almeido-Hill
1Department of International Health, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205.
Objective:
In this article we determine the incidence and clinical spectrum of invasive pneumococcal disease in the White Mountain Apache population, a group known to have a high incidence of invasive disease due to Haemophilus influenzae type b.
Design:
Patients from whom cultures of normally sterile body sites yielded Streptococcus pneumoniae were identified retrospectively through review of hospital laboratory records from a 6.8-year period. Clinical data were reviewed and incidence rates were computed.
Setting:
The Whiteriver Indian Health Service Hospital is located on the 1.7-million-acre White Mountain Apache Reservation in eastern Arizona.
Patients:
Approximately 10,000 members of the White Mountain Apache Tribe reside on or near the reservation and receive health care through the Whiteriver Indian Health Service Hospital.
Outcome Measures:
The average annual incidence rates of invasive pneumococcal disease were calculated and clinical characteristics were reviewed.
Results:
One hundred thirty-eight cases of invasive pneumococcal disease were identified. The average annual incidence rate was 207 per 100,000 population, and 156 per 100,000 population when adjusted for age by direct standardization to the 1988 US population. The incidence rate was highest in children between 1 and 2 years--2396 per 100,000. The overall case-fatality rate was 5%. Pneumococcal pneumonia was the diagnosis in 79% of the patients 5 years of age or older. Alcohol abuse, identified in 66% of the cases in adults, was the most common underlying medical condition.
Conclusion:
The incidence rates in White Mountain Apaches are the highest reported for any population. A vaccine effective in children would greatly benefit this population.
Insights
Invasive pneumococcal disease is highly prevalent in the White Mountain Apache population, with the highest reported incidence rates globally. A pneumococcal vaccine could significantly benefit this community, especially children.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- The White Mountain Apache population has a known high incidence of invasive diseases.
- Haemophilus influenzae type b infections were previously a significant concern in this population.
Purpose of the Study:
- To determine the incidence and clinical spectrum of invasive pneumococcal disease (IPD) in the White Mountain Apache population.
- To establish baseline data for public health interventions and vaccine strategies.
Main Methods:
- Retrospective review of hospital laboratory records over a 6.8-year period.
- Identification of patients with positive cultures for Streptococcus pneumoniae from sterile sites.
- Calculation of average annual incidence rates and review of clinical characteristics.
Main Results:
- 138 cases of IPD were identified, with an average annual incidence rate of 207 per 100,000 population.
- The highest incidence was observed in children aged 1-2 years (2396 per 100,000).
- Pneumococcal pneumonia was common in older patients, and alcohol abuse was a frequent comorbidity in adults.
Conclusions:
- The White Mountain Apache population exhibits the highest reported incidence rates of IPD globally.
- A vaccine effective against pneumococcal disease would offer substantial public health benefits to this population.