title: Invasive pneumococcal disease in the Northern Territory of Australia, 1994-1998.
abstract: To examine the epidemiology of invasive pneumococcal disease (IPD) in the Northern Territory of Australia as a basis for optimising vaccination and healthcare provision.
  
  
  
  Prospective laboratory surveillance, with information collected from hospital and clinic records.
  
  
  
  Northern Territory (NT) and rural communities in north-west South Australia served by an NT hospital, 1994-1998 (NT population is 27% Indigenous).
  
  
  
  IPD incidence and mortality, risk factors, clinical presentation and disease-causing serotypes in Indigenous and non-Indigenous people.
  
  
  
  425 cases of IPD were detected, with 77% in Indigenous people. IPD incidence was highest in Indigenous children aged < 2 years (1534 per 100,000 in central Australia), but about 100 per 100,000 in non-Indigenous children < 2 years and all Indigenous age groups aged > or = 15 years. Mean ages of those with disease were 39 years in Indigenous people and 48 years in non-Indigenous people (P = 0.006) and, of those who died, 41 and 53 years, respectively (P = 0.04). IPD risk factors were present in 72% of Indigenous and 55% of non-Indigenous patients aged > or = 2 years. Serotype results for 363 isolates showed that the 23-valent vaccine covered 68% and 85% of isolates from Indigenous and non-Indigenous people aged > or = 2 years, respectively, while the proposed seven-, nine- and 11-valent conjugate vaccines covered 58%, 66% and 67% of isolates, respectively, from Indigenous children aged < 2 years and 72% each of those from non-Indigenous children. Case-fatality rates were 10% in both Indigenous and non-Indigenous people.
  
  
  
  These data support the recent change in NT vaccination policy which extended funding for the 23-valent vaccine to all Indigenous people aged > or = 15 years and all Indigenous children in central Australia aged 2-5 years. The high rates of IPD in both Indigenous and non-Indigenous children mandate action to make conjugate vaccine available as soon as possible.
authors.affiliation: Centre for Disease Control, Territory Health Services, Darwin, NT. vicki.krause@nt.gov.au
authors.forename: V L
authors.initials: VL
authors.lastname: Krause
authors.forename: S J
authors.initials: SJ
authors.lastname: Reid
authors.forename: A
authors.initials: A
authors.lastname: Merianos
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007223:Infant; D008489:Medical Indigency; D008875:Middle Aged; D015876:Northern Territory / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D022242:Pneumococcal Vaccines; D011446:Prospective Studies; D012307:Risk Factors; D012423:Rural Health; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification; D014504:Urban Health
chemical_list: D022242:Pneumococcal Vaccines