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Previous Volume 354:1455-1463 April 6, 2006 Number 14 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Musher, D. M. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Related Article PubMed Citation

ABSTRACT

Background Five of seven serotypes in the pneumococcal conjugate vaccine, introduced for infants in the United States in 2000, are responsible for most penicillin-resistant infections. We examined the effect of this vaccine on invasive disease caused by resistant strains.

Methods We used laboratory-based data from Active Bacterial Core surveillance to measure disease caused by antibiotic-nonsusceptible pneumococci from 1996 through 2004. Cases of invasive disease, defined as disease caused by pneumococci isolated from a normally sterile site, were identified in eight surveillance areas. Isolates underwent serotyping and susceptibility testing.

Results Rates of invasive disease caused by penicillin-nonsusceptible strains and strains not susceptible to multiple antibiotics peaked in 1999 and decreased by 2004, from 6.3 to 2.7 cases per 100,000 (a decline of 57 percent; 95 percent confidence interval, 55 to 58 percent) and from 4.1 to 1.7 cases per 100,000 (a decline of 59 percent; 95 percent confidence interval, 58 to 60 percent), respectively. Among children under two years of age, disease caused by penicillin-nonsusceptible strains decreased from 70.3 to 13.1 cases per 100,000 (a decline of 81 percent; 95 percent confidence interval, 80 to 82 percent). Among persons 65 years of age or older, disease caused by penicillin-nonsusceptible strains decreased from 16.4 to 8.4 cases per 100,000 (a decline of 49 percent). Rates of resistant disease caused by vaccine serotypes fell 87 percent. An increase was seen in disease caused by serotype 19A, a serotype not included in the vaccine (from 2.0 to 8.3 per 100,000 among children under two years of age).

Conclusions The rate of antibiotic-resistant invasive pneumococcal infections decreased in young children and older persons after the introduction of the conjugate vaccine. There was an increase in infections caused by serotypes not included in the vaccine.

Source Information

From the Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta (M.H.K., R.R.F., E.R.Z., A.S., C.G.W.); the Minnesota Department of Health, Minneapolis (R.L., J.B.); Vanderbilt University School of Medicine (W.S.) and the Tennessee Department of Health (A.S.C.) — both in Nashville; the Connecticut Department of Public Health, Hartford (J.H.); the School of Public Health, University of California, Berkeley (A.R.); the Emerging Infections Programs, Oregon Department of Human Services, Health Division, Portland (A.R.T.); Johns Hopkins University Bloomberg School of Public Health, Baltimore (L.H.H.); the Monroe County Department of Health and the University of Rochester — both in Rochester, N.Y. (N.M.B.); Emory University School of Medicine and the Veterans Affairs Medical Center — both in Atlanta (M.M.F.); and the University of Texas Health Science Center, San Antonio (J.H.J.).

Address reprint requests to Dr. Whitney at CDC Mailstop C-23, 1600 Clifton Rd. NE, Atlanta, GA 30333, or at cwhitney{at}cdc.gov.

Full Text of this Article

Related Letters:

Potential Consequences of the Pneumococcal Conjugate Vaccine
Kopterides P., Falagas M. E., Kyaw M. H., Whitney C. G., the Active Bacterial Core Surveillance Team
Extract | Full Text | PDF  
N Engl J Med 2006; 355:95-96, Jul 6, 2006. Correspondence

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