title: Invasive pneumococcal disease and the potential for prevention by vaccination in the United Kingdom.
abstract: OBJECTIVE
  Invasive pneumococcal disease (IPD) is associated with a high mortality despite antimicrobial therapy, but may be preventable by pneumococcal vaccination. The extent of previous exposure to pneumococcal capsular polysaccharide vaccination prior to an episode of IPD in hospitalised adults in the United Kingdom is unclear.
  
  
  METHODS
  We conducted a retrospective cohort study in adults with IPD admitted to either of two teaching hospitals in Sheffield, United Kingdom during 1992-2000. Receipt of pneumococcal vaccination, risk factors for IPD, death and disability were determined.
  
  
  RESULTS
  The number of cases of IPD was 552 and 187/230 patient records from one site were reviewed. According to UK pneumococcal vaccination guidelines 59% of patients should have received the vaccine and 76% of patients if updated guidelines, which include age>65 years as an indication, are applied. In patients with known risk factors, excluding age, only 8% had been vaccinated. The mortality from IPD was 21% and an additional 6% suffered major complications.
  
  
  CONCLUSIONS
  In patients hospitalised with IPD there is a high rate of pre-existing risk factors and a low rate of administration of pneumococcal vaccination. IPD incurs significant mortality, morbidity and economic cost and there is potential for reducing this by improved uptake of pneumococcal vaccination.
authors.affiliation: Department of Microbiology, Sheffield Teaching Hospitals Trust, Sheffield S10 2RX, UK.
authors.forename: H K
authors.initials: HK
authors.lastname: Parsons
authors.forename: S C
authors.initials: SC
authors.lastname: Metcalf
authors.forename: K
authors.initials: K
authors.lastname: Tomlin
authors.forename: R C
authors.initials: RC
authors.lastname: Read
authors.forename: D H
authors.initials: DH
authors.lastname: Dockrell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000276:immunology / Q000302:isolation & purification; D006113:United Kingdom / Q000453:epidemiology; D014611:Vaccination
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines