450. Underlying medical conditions and Invasive Pneumococcal Disease in Adults
Session: Poster Abstract Session: Pneumococcal Vaccine in Children and Adults
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA IPD conditions poster final.pdf (339.1 kB)
  • Background: In the United States, conjugated pneumococcal vaccines are recommended for all infants, and for immunocompromised individuals of older ages.  Polysaccharide pneumococcal vaccines are recommended for older adults and others with underlying medical conditions, including asthma.  We examined the impact of underlying medical conditions on the development of invasive pneumococcal disease (IPD).

    Methods: Kaiser Permanente Northern California (KPNC) is an integrated health care plan serving approximately 3.3 million members.  IPD cases were identified by the KPNC Lab as S.pneumoniae from a normally sterile body site, from May 2005 through April 2011, in members age 18 and over.  Age and race were derived from KPNC membership databases.  We used KPNC registries to identify members with asthma, coronary artery disease (CAD), diabetes (DM), stroke, heart failure (HF), HIV infection, and hypertension (HTN).  Rates were calculated as Annual Incidence of IPD = (IPD cases / (Members / 105).  We used Poisson regression to estimate the incidence of IPD in relation to these conditions and demographic groups.  Results: The adjusted incidence rate ratio  of IPD for  persons with asthma versus without asthma was 5.68 (95%CI 4.90-6.56); for CAD 1.93 (1.57-2.36); DM: 2.41 (2.08-2.78); stroke: 5.02 (3.72-6.66); HF: 4.24 (3.42-5.25); HIV: 57.89 (42.27-77.46), and HTN: 1.13 (0.98-1.31).  The adjusted RR by race for Black (compared with White) was 3.52 (2.97-4.16), Asian: 1.68 (1.40-1.99), and Hispanic: 1.78 (1.52-2.08).  

    Conclusion: In adults,  HIV, asthma, HF, stroke, DM and CAD were associated with increased risk of IPD.   This has important implications for recommendations on who should receive pneumococcal vaccines.

    Roger Baxter, MD1, Arnold Yee, MBA1, G.Thomas Ray, MBA1, Bruce Fireman, MA1, Stephen Pelton, MD2, Charlie Chao1, Laurie Aukes, RN1 and Nicola Klein, MD, PhD1, (1)Kaiser Permanente Vaccine Study Center, Oakland, CA, (2)Pediatric Infectious Diseases, Boston Medical Center, Boston, MA

    Disclosures:

    R. Baxter, Pfizer: Grant Investigator, Grant recipient
    Merck & Co.: Grant Investigator, Grant recipient

    A. Yee, None

    G. T. Ray, None

    B. Fireman, None

    S. Pelton, Merck: Grant Investigator, Grant recipient
    Pfizer: Grant Investigator and Scientific Advisor, Grant recipient and Speaker honorarium
    Cempra: Grant Investigator, Grant recipient
    GSKbio: Scientific Advisor, Speaker honorarium

    C. Chao, None

    L. Aukes, None

    N. Klein, Pfizer: Grant Investigator, Grant recipient

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.