title: The epidemiology of community acquired bacteremic pneumonia, due to Streptococcus pneumoniae, in the Top End of the Northern Territory, Australia--over 22 years.
abstract: BACKGROUND
  Diseases caused by Streptococcus pneumoniae continue to cause substantial morbidity and mortality throughout the world. Furthermore, detrimental outcomes are more pronounced in some populations--such as those living in third world poverty, and Indigenous people who live in developed nations.
  
  
  METHODS
  This study describes the epidemiology of blood culture positive S. pneumoniae community-acquired pneumonia (CAP) in the Top End of the Northern Territory of Australia. Demographics, indigenous status, medical risk factors, serotype and outcomes were collected from adults presenting to hospital with blood culture positive S. pneumoniae CAP, from 1987 to 2008.
  
  
  RESULTS
  We report 205 cases, with a median age of 40 years. The average overall incidence rate ratio was 10.3 for indigenous adults compared with non-indigenous adults. There was no statistical difference between incidence rates pre and post-23-valent pneumococcal polysaccharide vaccine (23vPPV) introduction. Serotypes in presenting cases were predominantly (84.7%) 23vPPV types. The whole-population logistic regression model identified significant adjusted relative risks: 95% CI, for age 45 and older 1.6: 1.1, 2.2, indigenous 5.9: 3.7, 9.5, diabetes 2.3: 1.6, 3.3, excess alcohol 4.8: 2.8, 8.3, smoking 2.7: 1.9, 3.7 with indigenous+excess alcohol 18.5: 17.3, 19.7 as predictive for bacteremic S. pneumoniae CAP presentation.
  
  
  CONCLUSIONS
  Our results suggest that, the national 23vPPV program appears to be under-utilized. An integrated Public Health approach vigorously targeting indigenous adolescents, before substances such as alcohol and smoking are habitual, together with increased vaccine coverage, will reduce the burden of pneumococcal disease in this population.
authors.affiliation: School for Environmental Research, Charles Darwin University, Northern Territory, Australia. Susan.Jacups2@jcu.edu.au
authors.forename: Susan P
authors.initials: SP
authors.lastname: Jacups
authors.forename: Allen
authors.initials: A
authors.lastname: Cheng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D001769:Blood / Q000382:microbiology; D017714:Community-Acquired Infections / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015876:Northern Territory / Q000453:epidemiology; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D012307:Risk Factors; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D016896:Treatment Outcome; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines