1243. A Decade of Invasive Pneumococcal Disease in Ohio Veterans: Challenges in Resistance and Vaccination
Session: Poster Abstract Session: Clinical Infectious Diseases: Respiratory Infections
Friday, October 28, 2016
Room: Poster Hall
Posters
  • IPD poster FP Oct 19 GIF.gif (610.2 kB)
  • Background:

    Patients from the Veterans Healthcare Administration (VHA) are particularly vulnerable to invasive pneumococcal disease (IPD) because of their advanced age and comorbidities. Vaccination to prevent IPD is a VHA priority. We studied cases of IPD in the Ohio VHA to understand their characteristics, outcomes, and vaccination status.

    Methods:

    We identified patients with IPD (isolation of Streptococcus pneumoniae from a sterile site) in the Ohio VHA between 2006 and 2015, obtaining demographics, Charlson comorbidity index (CCI) and indications for pneumococcal vaccination. We compared IPD incidence, mortality after 30 days, and S. pneumoniae antibiotic susceptibility in the Ohio VHA with data from the Centers for Disease Control and Prevention’s (CDC) Active Bacterial Core (ABC) surveillance program (2006-2014, excluding cases among children).

    Results:

    Among 211 patients with IPD in the Ohio VHA, 70% were Caucasian, the mean age was 64.5 years with a mean CCI was 4.68. We observed decreasing trends in IPD incidence: from 11 to 7 cases/100,000 in Ohio VHA (2006-2010 vs. 2011-2015), and from 16 to 10 cases/100,000 in ABC (2006 vs. 2014). Mortality among Ohio VHA cases was 10%, similar to ABC cases (11% to 13% in 2006-2014). Since 2009, non-susceptibility to penicillin occurred in 18% of Ohio VHA isolates and in only 8% of ABC cases (Fig 1). Among Ohio VHA IPD cases, 10% occurred in veterans aged 18-49,   46% in those aged 50-64, and 44% in those 65 or older. Among adult ABC IPD cases, 28% occurred in people aged 18-49, 33% in those aged 50-64, and 39% in those 65 or older (Fig 2). In the Ohio VHA, 209 IPD cases had an indication for pneumococcal vaccination at the time of infection and 86 (41%) had a ‘high-risk’ immunosuppressive condition. Despite having an indication for pneumococcal vaccination, 33% were unvaccinated, 28% were partially vaccinated and 39% were up to date. Vaccination rates were lowest in veterans aged 18-49.

    Conclusion:

    Incidence trends and outcomes of IPD are similar between Ohio VHA and the CDC ABC surveillance populations. IPD cases in the Ohio VHA reflect an older population and had higher rates of penicillin non-susceptibility. These data reveal unique challenges posed by IPD among Ohio veterans and identify targets for vaccination efforts.

    Brigid Wilson, PhD, Geriatric Research, Education, and Clinical Center, Cleveland Vet. Medical Center, Cleveland, OH, Richard Banks, BS, Geriatric Research Center Clinical Center (GRECC), Louis Stokes Cleveland VA Medical Center, Cleveland, OH, Robin Jump, MD, PhD, Department of Medicine, Case Western Reserve University, Cleveland, OH and Federico Perez, MD, Medicine Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH; Case Western Reserve University, Cleveland, OH

    Disclosures:

    B. Wilson, None

    R. Banks, None

    R. Jump, Pfizer: Grant Investigator , Grant recipient

    F. Perez, Pfizer: Grant Investigator , Grant recipient
    Actavis: Consultant , Consulting fee

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