title: Racial disparities in invasive Streptococcus pneumoniae infections, 1998-2009.
abstract: BACKGROUND
  Before the introduction of 7-valent pneumococcal conjugate vaccine (PCV7), invasive pneumococcal disease (IPD) rates among blacks were twice the rates in whites. We measured the effects of trends in PCV7-type and non-PCV7-type IPD rates on racial disparities in overall IPD and estimated the proportion of IPD caused by serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13).
  
  
  METHODS
  We analyzed data from the Active Bacterial Core surveillance system, which performs active, laboratory- and population-based surveillance for IPD for 29.2 million people in the United States, for the period 1998-2009. For patients with unknown race, we multiplied imputed race to calculate age-, race-, and serotype-specific IPD incidence rates.
  
  
  RESULTS
  During 1998-2009, 47 449 IPD cases were identified; race was unknown for 5419 (11%). After multiple imputation, 31 981 (67%) patients were considered white and 13 750 (29%) black. PCV7-type IPD rates in all ages in both races decreased to <1 case per 100 000, whereas there were no decreases in overall IPD rates after 2002. By 2009, PCV13 serotypes caused 71% of cases among whites aged <5 years compared with 58% among blacks (P < .01). PCV13 serotypes caused 50% of IPD cases in whites aged ≥5 years compared with 43% among blacks (P < .01).
  
  
  CONCLUSIONS
  Despite near elimination of PCV7-type IPD in both races, overall disparities in IPD rates persisted because non-PCV7-type IPD rates are higher among blacks. Whereas PCV13 introduction may reduce racial disparities in IPD, higher valency conjugate vaccines and strategies to directly address underlying causes are needed to eliminate IPD disparities.
authors.affiliation: Epidemic Intelligence Service.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Wortham
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Zell
authors.forename: Tracy
authors.initials: T
authors.lastname: Pondo
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
authors.forename: Ann
authors.initials: A
authors.lastname: Thomas
authors.forename: Arthur
authors.initials: A
authors.lastname: Reingold
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Bennett
authors.forename: Susan
authors.initials: S
authors.lastname: Petit
authors.forename: Deborah
authors.initials: D
authors.lastname: Aragon
authors.forename: Joseph
authors.initials: J
authors.lastname: Bareta
authors.forename: Billie A
authors.initials: BA
authors.lastname: Juni
authors.forename: Monica M
authors.initials: MM
authors.lastname: Farley
authors.forename: Bernard
authors.initials: B
authors.lastname: Beall
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Moore
mesh_terms: D044383:Black People; D062665:Epidemiological Monitoring; D006801:Humans; D015994:Incidence; D011008:Pneumococcal Infections / Q000208:ethnology*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000276:immunology / Q000302:isolation & purification / Q000472:pathogenicity; D014481:United States; D018074:Vaccines, Conjugate / Q000627:therapeutic use; D044465:White People; D001741:Black or African American
chemical_list: C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
keywords: Streptococcus pneumoniae; continental population groups; pneumocccal vaccines