title: Persistent Sex Disparities in Invasive Pneumococcal Diseases in the Conjugate Vaccine Era.
abstract: Few studies have characterized the role of sex on the incidence of invasive pneumococcal disease (IPD). We examined sex differences in rates of IPD, and trends after the introduction of pneumococcal conjugate vaccines (PCVs).
  
  
  
  We used active population and laboratory-based IPD surveillance data from the Centers for Disease Control and Prevention Active Bacterial Core surveillance program (1998-2013) in Tennessee. Population-based rates of IPD by sex, race, age group, and PCV era were calculated. Rates were compared using incidence rate ratios.
  
  
  
  Throughout the study years, rates of IPD were higher in male than in female subjects, particularly in children <2 years and adults 40-64 years of age, with male subjects having IPD rates 1.5-2 times higher than female subjects. The proportions of comorbid conditions were similar in male and female subjects . Sex rate differences persisted after stratification by race. Although the introductions of 7-valent PCV (PCV7) and 13-valent PCV (PCV13) were associated with declines in IPD rates in both sexes, rates of IPD after PCV13 were still significantly higher in male than in female subjects among children and adults 40-64 and >74 years of age.
  
  
  
  Rates of IPD were generally higher in male than in female subjects. These sex differences were observed in different race groups and persisted after introduction of both PCVs.
authors.affiliation: Department of Pediatrics.
authors.forename: Annabelle
authors.initials: A
authors.lastname: de St Maurice
authors.affiliation: Department of Health Policy, Vanderbilt University.
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
authors.affiliation: Department of Health Policy, Vanderbilt University Department of Geriatric Research Education Clinical Center, VA Tennessee Valley, Nashville.
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
authors.affiliation: Department of Pediatrics.
authors.forename: Natasha
authors.initials: N
authors.lastname: Halasa
authors.affiliation: Department of Health Policy, Vanderbilt University Department of Geriatric Research Education Clinical Center, VA Tennessee Valley, Nashville.
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Grijalva
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine / Q000008:administration & dosage / Q000276:immunology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D012307:Risk Factors; D012737:Sex Factors; D013714:Tennessee / Q000453:epidemiology; D055815:Young Adult
chemical_list: C538862:13-valent pneumococcal vaccine; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines
keywords: pneumococcal conjugate vaccine; sex disparities; streptococcus pneumoniae