678. Rates of Invasive Pneumococcal Disease among Persons with and without Immunocompromising Conditions in the Era of Pneumococcal Conjugate Vaccine Use United States, 200709
Session: Oral Abstract Session: Pneumococcal Vaccine for All Ages
Friday, October 4, 2013: 11:00 AM
Room: The Moscone Center: 200-212
Background: Persons with immunocompromising conditions (IC) have a higher risk of invasive pneumococcal disease (IPD). Routine use of 7–valent pneumococcal conjugate vaccine (PCV) among children aged <5 years reduced IPD incidence in vaccinated children, and in unvaccinated older individuals with the exception of those with IC. CDC’s ACIP recently recommended 13–valent PCV (PCV-13) for persons aged >6 years with IC, including HIV, sickle cell disease (SCD), and hematologic malignancies (HM). We evaluated the potential benefits of PCV13 use in these populations.  

Methods: IPD cases, defined as isolation from a sterile site, were identified using active, population-based surveillance during 2007–09 (pre-PCV13 introduction). National estimates of IPD cases were obtained by extrapolating age– and race–adjusted surveillance cases to US population using Census data. The corresponding denominators were estimated using neonatal screening data for SCD, National Program of Cancer Registries for HM, and CDC’s HIV surveillance report (for children) and National Health Interview Survey (for adults). We compared IPD rates (cases/100,000 population) among persons with HM, HIV and SCD (African-American children only) with rates among persons without these conditions using rate ratios (RR) and 95% confidence intervals.

Results: During 2007–09, 10,882 IPD cases were identified among individuals > 6 years; 1,454 (13%) had IC (511 HM, 28 SCD, and 928 HIV/AIDS). PCV13–type IPD rates (per 100,000) were higher among children aged 6–18 years with HM (1,282 versus 1.6; RR: 822[687–983]), SCD (56 versus 2.1; RR: 27[9–73]), and HIV/AIDS (122 versus 1.6; RR: 122[94–161]) compared to those without. In 2009, PCV13–type IPD rates were higher in adults 18–64 years (67 vs. 4.1; RR: 16[6.0–44]) and >64 years (89 vs. 11; RR: 8[4.3–15]) with HIV, and in adults 18–64 years (68 vs. 4.1; RR: 17[6.1–45]) and >64 years (128 vs. 11; RR: 12[6.3–22]) with HM compared to healthy adults.

Conclusion: Rates of PCV13-type IPD in individuals > 6 years with IC were high pre-PCV13 introduction, especially among children under 18 years, suggesting that the new PCV13 recommendations may have a substantial impact in this population.

Aaron Harris, MD, MPH1, Ryan Gierke, MPH1, Amanda Payne, MPH2, Ruth Link-Gelles, MPH1, Jessica King, MPH3, Mi Chen, MS4, William Schaffner, MD5, Susan Petit, MPH6, Ann Thomas, MD, MPH7, Nancy M. Bennett, MD8, Monica M. Farley, MD9, Ruth Lynfield, MD10, Deborah Aragon, MSPH11, Arthur Reingold, MD12, Lee Harrison, MD13, Megin Nichols, DVM, MPH, DACVPM14, Tamara Pilishvili, MPH15 and Kathleen Dooling, MD, MPH1, (1)Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (2)Division of Blood Disorders, Ncbddd, Centers for Disease Control and Prevention, Atlanta, GA, (3)Division of Cancer Prevention, Nccdphp, Centers for Disease Control and Prevention, Chamblee, GA, (4)HIV Incidence and Case Surveillance Branch, Nchhstp, Centers for Disease Control and Prevention, Atlanta, GA, (5)Vanderbilt University School of Medicine, Nashville, TN, (6)Connecticut Emerging Infections Program, New Haven, CT, (7)Oregon Health Authority, Portland, OR, (8)Emerging Infections Program, University of Rochester, Rochester, NY, (9)Emory University and Atlanta Veterans Administration Medical Center, Atlanta, GA, (10)Acute Disease Investigation and Control, Minnesota Department of Health, St. Paul, MN, (11)Colorado Department of Public Health & Environment, Denver, CO, (12)University of California, Berkeley, CA, (13)University of Pittsburgh Medical Center, Pittsburgh, PA, (14)New Mexico Department of Health, Santa Fe, NM, (15)Respiratory Disease Branch, Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

A. Harris, None

R. Gierke, None

A. Payne, None

R. Link-Gelles, None

J. King, None

M. Chen, None

W. Schaffner, None

S. Petit, None

A. Thomas, None

N. M. Bennett, None

M. M. Farley, None

R. Lynfield, None

D. Aragon, None

A. Reingold, None

L. Harrison, None

M. Nichols, None

T. Pilishvili, None

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