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Invasive pneumococcal disease in the Kimberley, 1995-2001
1School of Public Health, The University of Western Australia, Nedlands, Western Australia 6009, Australia. makho@bigpond.com
Objective:
To describe the epidemiology of invasive pneumococcal disease (IPD) in the Kimberley and examine whether cases could have been prevented by vaccination.
Design:
Prospective case series of IPD cases from 1 January 1995 to 31 December 2001.
Setting:
The Kimberley region of far north-western Australia.
Subjects:
Seventy IPD cases in 37 men and 33 women aged 5 months to 90 years. Aboriginal people comprised 90% (63/70) of cases.
Main Outcome Measures:
Demographic, clinical and microbiological characteristics of IPD cases. Proportion of cases caused by vaccine-preventable serotypes. IPD incidence in the Kimberley.
Results:
Pneumonia and bacteraemia were the commonest clinical presentations. Of IPD cases, 15% (children) and 67% (adults) had a risk factor for IPD. The case fatality rate was 13%. Of cases, 46% (95% confidence interval (CI) 35-58%) were caused by serotypes covered by an age-appropriate vaccine. Of the 26 cases eligible for pneumococcal vaccination, only 4 (16%) had been appropriately vaccinated. IPD incidence in Aboriginal people aged 15 years and over declined from 97.8/100,000 person years (95% CI 56.5-139.1) in 1997 to 38.1/100,000 person years (95% CI 22.5-53.9) in 2001.
Conclusions:
The significant proportion of cases caused by vaccine-preventable serotypes and that was, therefore, preventable underscores the importance of pneumococcal vaccination.