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Impact of the conjugate pneumococcal vaccine in arkansas
Gordon E Schutze1, Nancy C Tucker, Edward O Mason
1Department of Pediatrics and Pathology, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, USA.
Insights
The heptavalent pneumococcal conjugate vaccine significantly reduced invasive pneumococcal disease in Arkansas, particularly in young children. However, there is a concerning rise in infections caused by non-vaccine serogroups.
Area of Science:
- Public Health
- Infectious Diseases
- Vaccinology
Background:
- The American Academy of Pediatrics recommended the heptavalent pneumococcal conjugate vaccine (PCV) for infants and children in 2000.
- This recommendation followed successful early trials demonstrating the vaccine's efficacy in preventing invasive pneumococcal disease.
Purpose of the Study:
- To assess the impact of the heptavalent PCV on invasive pneumococcal disease (IPD) in Arkansas.
- To analyze changes in IPD incidence, serogroup distribution, and penicillin susceptibility before and after vaccine introduction.
Main Methods:
- Comparative analysis of IPD data from Arkansas between 1998-2000 (pre-PCV) and 2001-2003 (post-PCV).
- Collection of demographic data, vaccination history, medical conditions, infection site, morbidity, and mortality.
- Serogrouping/serotyping of pneumococcal isolates and determination of penicillin susceptibility.
Main Results:
- Overall IPD incidence in Arkansas decreased significantly from 5.78 to 3.02 per 100,000 population (P=0.002).
- A marked reduction in IPD was observed among Black individuals and children 24 months of age or younger.
- Infections caused by non-vaccine serogroups increased substantially, from 3.7% to 44% of cases (P<0.001), particularly in young children.
Conclusions:
- The heptavalent PCV led to a significant reduction in invasive pneumococcal disease in Arkansas.
- A concerning increase in invasive pneumococcal isolates from non-vaccine serogroups necessitates ongoing surveillance and potential vaccine updates.
Background:
On the basis of the success of the early trials in the prevention of invasive pneumococcal disease in infants and children using a heptavalent conjugate pneumococcal vaccine, the American Academy of Pediatrics recommended in August 2000 that the vaccine be given concurrently with other childhood immunizations.
Methods:
Data concerning invasive pneumococcal infections from 1998-2000 were compared with 2001-2003 to assess the impact of the heptavalent pneumococcal conjugate vaccine in Arkansas. Basic demographic data were gathered as well as history of vaccination with the pneumococcal vaccine, underlying medical conditions, site of infection and morbidity and mortality. Pneumococcal isolates were serogrouped or serotyped and penicillin susceptibilities were obtained.
Results:
The incidence of invasive disease decreased from a high of 5.78/100,000 population to 3.02/100,000 population (P = 0.002). Although the percentage of White patients increased from 2001-2003, the overall incidence of disease did not change. The incidence of disease among Blacks fell from 20.5/100,000 population to 4.9/100,000 population. The greatest decrease of disease occurred in children 24 months of age or younger with the incidence rate falling from 44.2/100,00 population to 8.30/100,000 population (P < 0.02). The incidence among White children 24 months of age or younger fell from 19/100,000 population to 1.8/100,000 population, whereas that of Black children 24 months of age or younger declined from 164/100,000 to 35/100,000. From 1998 to 2000, 3.7/100 cases were from nonvaccine serogroups compared with 44/100 cases from 2001 to 2003 (P < 0.001). In children 24 months of age or younger, the number of nonvaccine isolates increased from 1.3/100 cases to 30.5/100 cases (P < 0.001). Overall 56 (44%) were nonsusceptible to penicillin from 1998 to 2000; that was not significantly different from 2001-2003 when 37 (46%) of 81 isolates were nonsusceptible to penicillin.
Conclusions:
A significant decrease of invasive pneumococcal disease has been documented in Arkansas. Of concern, however, is the increasing number of invasive isolates not included in the current vaccine.
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