Pneumococcal bacteremia in Hawaii: initial findings of a pneumococcal disease prevention project

The Hawaii Department of Health (DOH) recently established a pneumococcal disease initiative to determine the scope of serious pneumococcal disease in residents of Hawaii and to investigate methods of increasing vaccine utilization in the State. The initial phase of the project involved a review of pneumococcal bacteremia at all 38 microbiology laboratories in Hawaii during 1986 and 1987. Two hundred twenty-two residents with bacteremia were identified. Eighty-six percent of adults had pneumonia as the primary source of bacteremia. In children greater than 5 years old, pneumonia was present in 24%, otitis media in 35%, and meningitis in 11%. Bacteremia with no apparent focus of infection was found in 30% of children. The overall annual incidence of pneumococcal bacteremia was 9/10(5) population. Rates were highest in children greater than 2 years old (103/10(5] and persons greater than or equal to 65 years old (22/10(5]. These are similar to rates reported from other populations in the United States during the 1970s and early 1980s, but are less than those detected in 2 more recent population-based studies. The overall case-fatality rate in our study was relatively low (16%); however, 35% of persons greater than or equal to 65 years old died. A record of previous pneumococcal vaccination was found in the medical records of only 2 (1%) patients. Our study confirms that pneumococcal bacteremia causes significant morbidity and mortality among elderly residents of Hawaii and suggests that vaccine coverage is very low among this high-risk population. Phase 2 of the initiative included surveys of Hawaii physicians and the public to ascertain attitudes toward pneumococcal immunization.(ABSTRACT TRUNCATED AT 250 WORDS)