Exposure to Children as a Risk Factor for Bacteremic Pneumococcal Disease

May 30, 2010 at 4:46 pm Leave a comment

Arch Intern Med 8 April 2010 V.170 N.8 p.725-731

Changes in the Post–Conjugate Vaccine Era

Joshua P. Metlay, MD, PhD; Ebbing Lautenbach, MD, MPH, MSCE; Yimei Li, MS; Justine Shults, PhD; Paul H. Edelstein, MD

Departments of Medicine (Drs Metlay and Lautenbach), Biostatistics and Epidemiology (Drs Metlay, Lautenbach, and Shults and Ms Li), and Pathology and Laboratory Medicine (Dr Edelstein), and the Centers for Education and Research on Therapeutics (Drs Metlay and Lautenbach), University of Pennsylvania School of Medicine, Philadelphia.

Background

The introduction of a pneumococcal conjugate vaccine has been associated with a shift in the serotypes responsible for bacteremic pneumococcal disease. We examined recent trends in serotypes responsible for disease and current risk factors among adults.

Methods

Data were obtained from 48 acute care hospitals in the 5-county region surrounding Philadelphia, Pennsylvania, from October 1, 2002, through September 30, 2008, on all hospitalized adult patients with community-acquired bacteremic pneumococcal disease. Isolates were serotyped and patient characteristics were compared with data from a household survey of the adult population in the region.

Results

During the study period, the annual rate of disease due to vaccine serotypes declined by 29% per year, but the rate of disease due to nonvaccine serotypes increased 13% per year, yielding an overall 7% increase in the annual rate of disease among adults. Advanced age was a risk factor for infection with nonvaccine serotypes compared with vaccine serotypes. Comparing all patients with the source population, African Americans were at increased risk of infection, and the presence of additional children in the home was associated with decreased risk of disease. Smoking, advanced age, and diabetes mellitus remained important risk factors in adults.

Conclusions

New serotypes are replacing the serotypes covered in the conjugate vaccine. While some risk factors for pneumococcal disease remain unchanged, the observation that exposure to children in the home is associated with lower risk of disease suggests that the changing epidemiology of pneumococcal disease may be altering the dominant modes of transmission in the community.

abstract

http://archinte.ama-assn.org/cgi/content/abstract/170/8/725?etoc

Entry filed under: Bacterias, Bacteriemias, Epidemiología, Infecciones respiratorias, Inmunizaciones.

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