title: Association Between Local Pediatric Vaccination Rates and Patterns of Pneumococcal Disease in Adults.
abstract: BACKGROUND
  Pneumococcal conjugate vaccine (PCV) is now recommended for use in adults in the United States. Because vaccination of children with PCVs protects adults from the targeted serotypes, local variations in PCV uptake among children could influence disease patterns in adults.
  
  
  METHODS
  We obtained ZIP code-level data on invasive pneumococcal disease (IPD) from an active population-based surveillance system in Connecticut (study interval, 1998-2009) and ZIP code-level data on immunization with at least 3 or at least 4 doses of 7-valent PCV (PCV7) from the state immunization registry. We fit logistic regression models to estimate the proportion of IPD cases among adults aged >40 years that were caused by PCV7-targeted serotypes. Covariates included ZIP code-level socioeconomic indicators (eg, percentage of the population that was black and income per capita), the percentage of the population that received 3 or 4 doses of PCV7 (mean centered), and a linear spline to control for the average rate of decline across all ZIP codes.
  
  
  RESULTS
  ZIP codes that had a higher proportion of children that did not complete the 4-dose PCV7 series had a higher proportion of adult IPD cases caused by PCV7 serotypes.
  
  
  CONCLUSIONS
  Local variations in PCV uptake (and receipt of the booster dose) might influence the effectiveness of PCVs in preventing pneumococcal disease in adults.
authors: Department of Epidemiology of Microbial Diseases, Yale School of Public Health.
authors: Sundia Cassandra
authors: SC
authors: Pingali
authors: Department of Biostatistics, Yale School of Public Health.
authors: Joshua L
authors: JL
authors: Warren
authors: Department of Epidemiology of Microbial Diseases, Yale School of Public Health.
authors: Aimee M
authors: AM
authors: Mead
authors: Connecticut Department of Public Health, New Haven, Connecticut.
authors: Nancy
authors: N
authors: Sharova
authors: Connecticut Department of Public Health, New Haven, Connecticut.
authors: Susan
authors: S
authors: Petit
authors: Department of Epidemiology of Microbial Diseases, Yale School of Public Health.
authors: Daniel M
authors: DM
authors: Weinberger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003237:Connecticut / Q000453:epidemiology; D000069443:Heptavalent Pneumococcal Conjugate Vaccine / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000302:isolation & purification; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine
keywords: conjugate vaccine; herd immunity; indirect effects; pneumococcal