Invasive pneumococcal disease in an underimmunized, high HIV prevalence population.
OBJECTIVE
To describe the epidemiology of invasive pneumococcal disease (IPD) in a predominantly minority population with low childhood immunization rates and high HIV prevalence, during the early childhood pneumococcal vaccine (PCV7) era.


METHODS
A retrospective cases series analysis of 131 patients diagnosed with IPD at University Hospital in Newark, NJ from 2000 through 2005, and who had their pneumococcal isolates serotyped, was conducted. Changes in IPD over time were analyzed with the Cochran-Armitage test and linear regression. Multivariate logistic regression was conducted to determine risk factors for non-vaccine type IPD.


RESULTS
Ninety-two percent of cases occurred in older children (>or=5 years) and adults, with 53.4% occurring in the 34-49 year-old age group. 90% of cases were black and 48% were HIV-infected. Among cases five years or older, there was a significant decrease in the proportion of IPD caused by vaccine serotypes (2000: 45.5%, 2001: 50.0%, 2002: 31.8%, 2003: 30.0%, 2004: 0.0%, 2005: 0.0%; p<0.0005). Concomitantly, PCV7 immunization rates among Newark infants increased (2002: 30.5%, 2003: 58.1%, 2004: 70.9%, 2005: 75.6%). Risk factors for non-vaccine type IPD included year of diagnosis and older male.


CONCLUSIONS
At-risk populations, with high HIV prevalence and relatively low infant PCV7 immunization rates, may still be benefiting from PCV7-related herd protection effects.
Tasslimi
Azadeh
A
UMDNJ - School of Public Health, 65 Bergen Street, Newark, NJ 07107, USA.
Wenger
Peter
P
Pentakota
Sri Ram
SR
Brimacombe
Michael
M
Burday
Michele
M
Sinha
Anushua
A
D000328:Adult; D044383:Black People; D002648:Child; D002675:Child, Preschool; D015658:HIV Infections / Q000453:epidemiology*; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006785:Hospitals, University; D006801:Humans; D032521:Immunity, Herd; D017589:Immunization Programs / Q000706:statistics & numerical data; D015994:Incidence; D022401:Meningococcal Vaccines / Q000008:administration & dosage / Q000276:immunology; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000208:ethnology / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology; D015995:Prevalence; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000276:immunology; D014611:Vaccination / Q000706:statistics & numerical data; D001741:Black or African American
D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines