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Pneumococcal disease in a medium-sized community in the United States
Abstract:
To assess the importance of bacteremic pneumococcal disease among the population of one "average" American community, we studied all hospitalized patients who had Streptococcus pneumoniae isolated from blood, CSF, pleural fluid, or ascitic fluid during the years 1978 through 1981 in Huntington, WVa, and environs. Seventeen patients were children younger than 13 years, and 71 were adults. The case fatality rate from bacteremic pneumococcal disease among adults was 30%, and among children it was 6%. It was much higher (88%) in adults older than 50 years with extrapulmonary disease. Approximately four fifths of the typed isolates from adults or children were types included in the current vaccine. Eighty-nine percent of the adults who died of pneumococcal infection had been candidates for pneumococcal vaccine, but only one patient had received vaccine, just before becoming ill with pneumococcal disease. These data provide a basis for widespread use of pneumococcal vaccine in high-risk groups.
Insights
Bacteremic pneumococcal disease is a significant threat, especially for older adults. Vaccination could prevent many deaths, as most fatal cases involved eligible unvaccinated individuals.
Area of Science:
- Infectious Diseases
- Epidemiology
- Vaccinology
Background:
- Bacteremic pneumococcal disease (BPD) poses a considerable public health challenge.
- Understanding the epidemiology of BPD is crucial for effective prevention strategies.
Purpose of the Study:
- To evaluate the impact and characteristics of BPD in an average American community.
- To assess the potential benefit of pneumococcal vaccination.
Main Methods:
- Retrospective study of hospitalized patients with Streptococcus pneumoniae isolated from sterile sites (blood, CSF, pleural, ascitic fluid).
- Data collected from 1978-1981 in Huntington, West Virginia.
- Analysis of case fatality rates and vaccine-preventable serotypes.
Main Results:
- Seventy-one adults and 17 children were identified with BPD.
- Overall case fatality rates were 30% for adults and 6% for children.
- Adults over 50 with extrapulmonary disease had an 88% fatality rate.
- Approximately 80% of isolates were vaccine-preventable serotypes.
- 89% of deceased adults were vaccine candidates, but only one was vaccinated.
Conclusions:
- BPD is a serious condition with high mortality, particularly in older adults.
- The current pneumococcal vaccine covers most prevalent serotypes causing BPD.
- Widespread vaccination in high-risk populations could significantly reduce BPD-related mortality.