title: Racial and Regional Differences in Rates of Invasive Pneumococcal Disease.
abstract: OBJECTIVE
  Invasive pneumococcal disease (IPD) remains an important cause of illness in US children. We assessed the impact of introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) on pediatric IPD rates, as well as changes in racial and regional differences in IPD, in Tennessee.
  
  
  METHODS
  Data from active laboratory and population-based surveillance of IPD were used to compare IPD rates in the early-PCV7 (2001-2004), late-PCV7 (2005-2009), and post-PCV13 (2011-2012) eras. IPD rates were further stratified according to age, race, and region (east and middle-west TN).
  
  
  RESULTS
  Among children aged <2 years, IPD rates declined by 70% from 67 to 19 per 100 000 person-years in the early-PCV7 era and post-PCV13 era, respectively. Similar decreasing trends in IPD rates were observed in older children aged 2 to 4 years and 5 to 17 years. In the late-PCV7 era, IPD rates in children aged <2 years were higher in black children compared with white children (70 vs 43 per 100 000 person-years); however, these racial differences in IPD rates were no longer significant after PCV13 introduction. Before PCV13, IPD rates in children aged <2 years were also higher in east Tennessee compared with middle-west Tennessee (91 vs 45 per 100 000 person-years), but these differences were no longer significant in the post-PCV13 era.
  
  
  CONCLUSIONS
  PCV13 introduction led to substantial declines in childhood IPD rates and was associated with reduced regional and racial differences in IPD rates in Tennessee.
authors.affiliation: Departments of Pediatrics.
authors.forename: Annabelle
authors.initials: A
authors.lastname: de St Maurice
authors.affiliation: Health Policy, and.
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Grijalva
authors.affiliation: Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Christopher
authors.initials: C
authors.lastname: Fonnesbeck
authors.affiliation: Health Policy, and.
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
authors.affiliation: Departments of Pediatrics, natasha.halasa@vanderbilt.edu.
authors.forename: Natasha B
authors.initials: NB
authors.lastname: Halasa
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D065288:Serogroup; D013714:Tennessee / Q000453:epidemiology; D018074:Vaccines, Conjugate / Q000627:therapeutic use*
chemical_list: C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate