title: Do community-level predictors of pneumococcal carriage continue to play a role in the conjugate vaccine era?
abstract: This paper examined whether previously identified community-level factors (high proportion of crowded households and/or persons below the poverty level) remained associated with childhood pneumococcal carriage in the heptavalent pneumococcal conjugate vaccine (PCV7) era. Using logistic regression, individual factors were used to develop base models to which community-level factors were added to evaluate impact on pneumococcal carriage within two paediatric study cohorts from Massachusetts (urban Boston, outside Boston). Six years after introduction of universal childhood PCV7 vaccination, we found no consistent evidence that census tract characteristics (e.g. population size and density, age and race distribution, percent participating in group childcare, parental education, percent lacking in-unit plumbing, poverty, and community stability) affected odds of pneumococcal carriage when added to individual predictors (e.g. younger age, current respiratory tract infections, and attendance in group childcare). How community-level factors influence pneumococcal carriage continues to change in the era of increasing immunization coverage.
authors.affiliation: Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, MA, USA.
authors.forename: K K
authors.initials: KK
authors.lastname: Hsu
authors.affiliation: Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Rifas-Shiman
authors.affiliation: Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Shea
authors.affiliation: Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA.
authors.forename: K P
authors.initials: KP
authors.lastname: Kleinman
authors.affiliation: Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Lee
authors.affiliation: Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Lakoma
authors.affiliation: Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, MA, USA.
authors.forename: S I
authors.initials: SI
authors.lastname: Pelton
authors.affiliation: Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Finkelstein
authors.affiliation: Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Huang
mesh_terms: D001900:Boston / Q000453:epidemiology; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D002675:Child, Preschool; D005191:Family Characteristics; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D018074:Vaccines, Conjugate / Q000627:therapeutic use
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate