title: Impact of heptavalent pneumococcal conjugate vaccine on invasive disease, antimicrobial resistance and colonization in Alaska Natives: progress towards elimination of a health disparity.
abstract: We evaluated invasive pneumococcal disease (IPD), antimicrobial resistance and nasopharyngeal colonization before and after introduction of pneumococcal conjugate vaccine (PCV7) in Alaska Natives (AN), a population with high IPD rates. We obtained IPD rates from population-based surveillance. Colonization was determined from annual surveys among rural AN of all ages and from urban children. After vaccine introduction, vaccine-type IPD rates declined by 91% among AN children <2 years, by 80% among non-Natives <2 years, and by 40% for adults of all races (P<0.001 each). IPD decreased for isolates resistant to penicillin, erythromycin and cotrimoxazole (P<0.001 each). Vaccine-type colonization decreased among rural and urban children <5 years and among rural adults (P<0.001 each). PCV7 vaccine has eliminated a longstanding disparity of vaccine-type IPD for AN children. Decreased vaccine-type colonization and IPD in adults demonstrate indirect vaccine effects.
authors.affiliation: Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK 99508, USA. thennessey@cdc.gov
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Hennessy
authors.forename: Rosalyn J
authors.initials: RJ
authors.lastname: Singleton
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Bulkow
authors.forename: Dana L
authors.initials: DL
authors.lastname: Bruden
authors.forename: Debby A
authors.initials: DA
authors.lastname: Hurlburt
authors.forename: Debra
authors.initials: D
authors.lastname: Parks
authors.forename: Matthew
authors.initials: M
authors.lastname: Moore
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Parkinson
authors.forename: Anne
authors.initials: A
authors.lastname: Schuchat
authors.forename: Jay C
authors.initials: JC
authors.lastname: Butler
mesh_terms: D000293:Adolescent; D000328:Adult; D000413:Alaska; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D022401:Meningococcal Vaccines / Q000627:therapeutic use*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000627:therapeutic use; D011159:Population Surveillance
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines