Chapter 10 : Epidemiology of Pneumococcal Disease

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This chapter focuses on the epidemiology of pneumococcal disease in terms of pathogen characteristics and host risk factors. The clinical manifestations of infection are protean but can be classified into two major categories: invasive infections, where the organism is isolated from a normally sterile body site, such as the bloodstream or central nervous system, and mucosal infections, most often involving the upper respiratory tract. Our understanding of pneumococcal disease epidemiology is further refined through studies of specific strains of . Differences in the polysaccharide structure of the pneumococcal capsule have permitted identification of at least 90 serotypes of . Pneumococcal polysaccharide and polysaccharide conjugate vaccines protect against disease by inducing serotype-specific antibodies. Vaccination with pneumococcal conjugate vaccine causes a shift in serotypes causing otitis media. The risk and severity of pneumococcal infection is increased for persons with certain chronic medical conditions, including functional or anatomic asplenia, HIV infection, chronic obstructive pulmonary disease, asthma, cirrhosis, diabetes mellitus, chronic renal failure, cancer (particularly hematological malignancies), organ or bone marrow transplantation, nephritic syndrome, and hypogammaglobulinemia and for persons taking immunosuppressive medications, such as corticosteroid. In temperate areas, pneumococcal infections are more common during the winter months, when respiratory viral infections are most common. Vaccination promises to have the most profound impact on preventing illness and death from pneumococcal disease since the advent of antimicrobial drug therapy.

Citation: Butler J. 2004. Epidemiology of Pneumococcal Disease, p 148-168. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch10

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Upper Respiratory Tract Infections
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Incidence of invasive pneumococcal disease by age and race, United States. Data for whites and blacks are from CDC surveillance conducted in the San Francisco Bay area, Calif.; Connecticut; metropolitan Atlanta, Ga.; Baltimore, Md.; Minneapolis-St. Paul, Minn.; Rochester, N.Y.; Portland, Oreg.; five urban counties in Tennessee; and San Antonio, Tex., 1998 ( ). Data for Alaska Natives are from CDC surveillance in Alaska, 1996 to 2000 (CDC, unpublished).

Citation: Butler J. 2004. Epidemiology of Pneumococcal Disease, p 148-168. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch10
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Incidence of invasive pneumococcal disease by age group and race among children aged <5 years, United States. Data are from CDC surveillance ( ).

Citation: Butler J. 2004. Epidemiology of Pneumococcal Disease, p 148-168. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch10
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Prevalence of nasopharyngeal colonization by age among residents of rural communities in Alaska, 2000 to 2001 (CDC, unpublished).

Citation: Butler J. 2004. Epidemiology of Pneumococcal Disease, p 148-168. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch10
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1. Abbasi, S.,, S. L. Orlicek,, I. Almohsen,, G. Luedtke,, and B. K. English. 1996. Septic arthritis and osteomyelitis caused by penicillin and cephalosporin-resistant Streptococcus pneumoniae in a children’s hospital. Pediatr. Infect. Dis. J. 15:7883.
2. Abrahamsen, A. F.,, E. A. Hoiby,, E. Hannisdal,, O. G. Jorgensen,, H. Holte,, V. Hasseltvedt,, and H. Host. 1997. Systemic pneumococcal disease after staging splenectomy for Hodgkins disease 1969-1980 without pneumococcal vaccine protection: a follow-up study. Eur. J. Haematol. 58:7377.
3. Amber, I. J.,, E. M. Gilbert,, G. Schiffman,, and J. A. Jacobson. 1990. Increased risk of pneumococcal infections in cardiac transplant recipients. Transplantation 49:122125.
4. Arlievsky, N.,, K. I. Li,, and J. L. Munoz. 1998. Septic arthritis with osteomyelitis due to Streptococcus pneumoniae in human immunodeficiency virus-infected children. Clin. Infect. Dis. 27:898899.
5. Aronin, S. I.,, S. K. Mukherjee,, J. C. West,, and E. L. Cooney. 1998. Review of pneumococcal endocarditis in adults in the penicillin era. Clin. Infect. Dis. 26:165171.
6. Austrian, R. 1977. Prevention of pneumococcal infection by immunization with capsular polysaccharides of Streptococcus pneumoniae: current status of polyvalent vaccines. J. Infect. Dis. 136:S38S42.
7. Austrian, R. 1981. Some observations on the pneumococcus and on the current status of pneumococcal disease and its prevention. Rev. Infect. Dis. 3:S1S17.
8. Austrian, R.,, R. M. Douglas,, G. Schiffman,, A. M. Coetzee,, H. J. Koornhof,, S. Hayden-Smith,, and R. D. Reid. 1976. Prevention of pneumococcal pneumonia by vaccination. Trans. Assoc. Am. Phys. 89:184194.
9. Austrian, R.,, V. M. Howie,, and J. H. Ploussard. 1977. The bacteriology of pneumococcal otitis media. Johns Hopkins Med. J. 141:104111.
10. Babl, F. E.,, S. I. Pelton,, S. Theodore,, and J. O. Klein. 2001. Constancy of distribution of serogroups of invasive pneumococcal isolates among children: experience during 4 decades. Clin. Infect. Dis. 32:11551161.
11. Ballon-Landa, G. R.,, G. Gherardi,, B. Beall,, S. Krosner,, and V. Nizet. 2001. Necrotizing fasciitis due to penicillin-resistant Streptococcus pneumoniae: case report and review of the literature. J. Infect. 42:272277.
12. Barry, M. A.,, D. E. Craven,, and M. Finland. 1984. Serotypes of Streptococcus pneumoniae isolated from blood cultures at Boston City Hospital between 1979 and 1982. J. Infect. Dis. 149:449452.
13. Benin, A. L.,, K. L. O’Brien,, J. P. Watt,, R. Reid,, E. R. Zell,, S. Katz,, C. Donaldson,, A. Parkinson,, A. Schuchat,, M. Santosham,, and C. G. Whitney. 2003. Effectiveness of the 23-valent polysaccharide vaccine against invasive pneumococcal disease in Navajo adults. J. Infect. Dis. 188:8189.
14. Berk, S. L.,, K. A. Gage,, S. A. Holtsclaw-Berk,, and J. K. Smith. 1985. Type 8 pneumococcal pneumonia: an outbreak on an oncology ward. South. Med. J. 78:159161.
15. Bisno, A. L.,, J. P. Griffin,, K. A. Van Epps,, H. B. Niell,, and M. W. Rytel. 1971. Pneumonia and Hong Kong influenza: a prospective study of the 1968-1969 epidemic. Am. J. Med. Sci. 261:251263.
16. Block, S. L. 1997. Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media. Pediatr. Infect. Dis. J. 16:449456.
17. Block, S. L.,, J. Hedrick,, C. J. Harrison,, R. Tyler,, A. Smith,, R. Findlay,, and E. Keegan. 2002. Pneumococcal serotypes from acute otitis media in rural Kentucky. Pediatr. Infect. Dis. J. 21:859865.
18. Borer, A.,, H. Meirson,, N. Peled,, N. Porat,, R. Dagan,, D. Fraser,, J. Gilad,, N. Zehavi,, and P. Yagupsky. 2001. Antibiotic-resistant pneumococci carried by young children do not appear to disseminate to adult members of a closed community. Clin. Infect. Dis. 33:436444.
19. Brandileone, M. C.,, A. L. de Andrade,, J. L. Di Fabio,, M. L. Guerra,, and R. Austrian. 2003. Appropriateness of a pneumococcal conjugate vaccine in Brazil: potential impact of age and clinical diagnosis, with emphasis on meningitis. J. Infect. Dis. 187:12061212.
20. Brandt, J.,, C. Wong,, S. Mihm,, J. Roberts,, J. Smith,, E. Brewer,, R. Thiagarajan,, and B. Warady. 2002. Invasive pneumococcal disease and hemolytic uremic syndrome. Pediatrics 110:371376.
21. Breiman, R. F.,, D. W. Keller,, M. A. Phelan,, D. H. Sniadack,, D. S. Stephens,, D. Rimland,, M. M. Farley,, A. Schuchat,, and A. L. Reingold. 2000. Evaluation of effectiveness of the 23-valent pneumococcal capsular polysaccharide vaccine for HIV-infected patients. Arch. Intern. Med. 160:26332638.
22. Breton, J. R.,, G. Pi,, L. Lacruz,, I. Calvo,, I. Rodriguez,, A. Sanchez,, J. J. Camarena,, and R. Hernandez. 2001. Pneumococcal pyomyositis. Pediatr. Infect. Dis. J. 20:8587.
23. Broome, C. V.,, R. R. Facklam,, and D. W. Fraser. 1980. Pneumococcal disease after pneumococcal vaccination: an alternative method to estimate the efficacy of pneumococcal vaccine. N. Engl. J. Med. 303:549552.
24. Brown, J. W.,, and J. C. Lockhart. 1949. Pneumococcic infections in adults at the San Francisco hospital from 1932 to 1946. Am. Pract. (Philadelphia) 4:214217.
25. Brueggemann, A. B.,, D. T. Griffiths,, E. Meats,, T. Peto,, D. W. Crook,, and B. G. Spratt. 2003. Clonal relationships between invasive and carriage Streptococcus pneumoniae and serotype- and clone-specific differences in invasive disease potential. J. Infect. Dis. 187:14241432.
26. Bullowa, J. G. M.,, and C. Wilcox. 1935. Incidence of bacteremia in the pneumonias and its relation to mortality. Arch. Intern. Med. 55:558573.
27. Bunim, J. J.,, and J. D. Trask. 1935. Familial studies on lobar pneumonia: epidemiologic studies on families of children with pneumococcic lobar pneumonia. Am. J. Dis. Child. 50:626635.
28. Burman, L. A.,, R. Norrby,, and B. Trollfors. 1985. Invasive pneumococcal infections: incidence, predisposing factors, and prognosis. Rev. Infect. Dis. 7:133142.
29. Butler, J. C.,, R. F. Breiman,, J. F. Campbell,, H. B. Lipman,, C. V. Broome,, and R. R. Facklam. 1993. Pneumococcal polysaccharide vaccine efficacy: an evaluation of current recommendations. JAMA 270:18261831.
30. Butler, J. C.,, R. F. Breiman,, H. B. Lipman,, J. Hofmann,, and R. R. Facklam. 1995. Serotype distribution of Streptococcus pneumoniae infections among preschool children in the United States, 1978-1994: implications for development of a conjugate vaccine. J. Infect. Dis. 171:885889.
31. Butler, J. C.,, J. L. Lennox,, L. K. McDougal,, J. A. Sutcliffe,, A. Tait-Kamradt,, and F. C. Tenover. 2003. Macrolide-resistant pneumococcal endocarditis and epidural abscess that develop during erythromycin therapy. Clin. Infect. Dis. 36:e19e25.
32. Butler, J. C.,, and A. Schuchat. 1999. Epidemiology of pneumococcal infections in the elderly. Drugs Aging 15:1119.
33. Cabrera, G. R.,, J. D. Fortenberry,, B. L. Warshaw,, C. R. Chambliss,, J. C. Butler,, and B. G. Cooperstone. 1998. Hemolytic uremic syndrome associated with invasive Streptococcus pneumoniae infection. Pediatrics 101:699703.
34. Capdevila, O.,, R. Pallares,, I. Grau,, F. Tubau,, J. Linares,, J. Ariza,, and F. Gudiol. 2001. Pneumococcal peritonitis in adult patients: report of 64 cases with special reference to emergence of antibiotic resistance. Arch. Intern. Med. 161:17421748.
35. Castle, S. C. 2000. Clinical relevance of agerelated immune dysfunction. Clin. Infect. Dis. 31:578585.
36.Centers for Disease Control and Prevention. 2001. Outbreak of pneumococcal pneumonia among unvaccinated residents of a nursing home—New Jersey, April 2001. Morb. Mortal. Wkly. Rep. 50:707710.
37.Centers for Disease Control and Prevention. 1997. Outbreaks of pneumococcal pneumonia among unvaccinated residents of chronic care facilities—Massachusetts, October 1995, Oklahoma, February 1996, and Maryland, May-June 1996. Morb. Mortal. Wkly. Rep. 46:6062.
38.Centers for Disease Control and Prevention. 2003. Pneumococcal conjunctivitis at an elementary school—Maine, September 20-December 6, 2002. Morb. Mortal. Wkly. Rep. 52:6466.
39.Centers for Disease Control and Prevention. 2000. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices (ACIP). Morb. Mortal. Wkly. Rep(RR-9). 49:135.
40. Chen, F. M.,, R. F. Breiman,, M. Farley,, B. Plikaytis,, K. Deaver,, and M. S. Cetron. 1998. Geocoding and linking data from population-based surveillance and the US Census to evaluate the impact of median household income on the epidemiology of invasive Streptococcus pneumoniae infections. Am. J. Epidemiol. 148:12121218.
41. Cherian, T.,, M. C. Steinhoff,, L. H. Harrison,, D. Rohn,, L. K. McDougal,, and J. Dick. 1994. A cluster of invasive pneumococcal disease in young children in child care. JAMA 271:695697.
42. Chilcote, R. R.,, R. L. Baehner,, and D. Hammond. 1976. Septicemia and meningitis in children splenectomized for Hodgkin’s disease. N. Engl. J. Med. 295:798800.
43. Cid, M.,, and N. R. Sabates. 1997. Penicillinresistant Streptococcus pneumoniae endophthalmitis. Am. J. Ophthalmol. 123:133135.
44. Collazos, J.,, A. Fernandez,, E. Martinez,, J. Mayo,, and J. M. delaViuda. 1996. Pneumococcal pyomyositis: case report, review of the literature, and comparison with classic pyomyositis caused by other bacteria. Arch. Intern. Med. 156:14701474.
45. Collazos, J.,, M. Garcia-Cuevas,, E. Martinez,, J. Mayo,, and I. Lekuona. 1996. Prosthetic valve endocarditis due to Streptococcus pneumoniae. Arch. Intern. Med. 156:2141, 2146, 2148.
46. Corso, A.,, E. P. Severina,, V. F. Petruk,, Y. R. Mauriz,, and A. Tomasz. 1998. Molecular characterization of penicillin-resistant Streptococcus pneumoniae isolates causing respiratory disease in the United States. Microb. Drug Resist. 4:325337.
47. Cortese, M. M.,, M. Wolff,, J. Almeido-Hill,, R. Reid,, J. Ketcham,, and M. Santosham. 1992. High incidence rates of invasive pneumococcal disease in the White Mountain Apache population. Arch. Intern. Med. 152:22772282.
48. Craig, A. S.,, P. C. Erwin,, W. Schaffner,, J. A. Elliott,, W. L. Moore,, X. T. Ussery,, L. Patterson,, A. D. Dake,, S. G. Hannah,, and J. C. Butler. 1999. Carriage of multidrug-resistant Streptococcus pneumoniae and impact of chemoprophylaxis during an outbreak of meningitis at a day care center. Clin. Infect. Dis. 29:12571264.
49. Crewe-Brown, H. H.,, A. S. Karstaedt,, G. L. Saunders,, M. Khoosal,, N. Jones,, A. Wasas,, and K. P. Klugman. 1997. Streptococcus pneumoniae blood culture isolates from patients with and without human immunodeficiency virus infection: alterations in penicillin susceptibilities and in serogroups or serotypes. Clin. Infect. Dis. 25:11651172.
50. Dagan, R.,, S. Gradstein,, I. Belmaker,, N. Porat,, Y. Siton,, G. Weber,, J. Janco,, and P. Yagupsky. 2000. An outbreak of Streptococcus pneumoniae serotype 1 in a closed community in southern Israel. Clin. Infect. Dis. 30:319321.
51. Daum, R. S.,, J. P. Nachman,, C. D. Leitch,, and F. C. Tenover. 1994. Nosocomial epiglottitis associated with penicillin- and cephalosporinresistant Streptococcus pneumoniae bacteremia. J. Clin. Microbiol. 32:246248.
52. Davidson, M.,, A. J. Parkinson,, L. R. Bulkow,, M. A. Fitzgerald,, H. V. Peters,, and D. J. Parks. 1994. The epidemiology of invasive pneumococcal disease in Alaska, 1986-1990—ethnic differences and opportunities for prevention. J. Infect. Dis. 170:368376.
53. Del Beccaro, M. A.,, P. M. Mendelman,, A. F. Inglis,, M. A. Richardson,, N. O. Duncan,, C. R. Clausen,, and T. L. Stull. 1992. Bacteriology of acute otitis media: a new perspective. J. Pediatr. 120:8184.
54. De Lencastre, H.,, and A. Tomasz. 2002. From ecological reservoir to disease: the nasopharynx, day-care centres and drug-resistant clones of Streptococcus pneumoniae. J. Antimicrob. Chemother. 50:7581.
55. DeMaria, A., Jr., K. Browne, S. L. Berk, E. J. Sherwood, and W. R. McCabe. 1980. An outbreak of type 1 pneumococcal pneumonia in a men’s shelter. JAMA 244:14461449.
56. Donaldson, S. S.,, E. Glatstein,, and K. L. Vosti. 1978. Bacterial infections in pediatric Hodgkin’s disease: relationship to radiotherapy, chemotherapy and splenectomy. Cancer 41:19491958.
57. Dowell, S. F.,, C. G. Whitney,, C. Wright,, C. E. Rose, Jr., and A. Schuchat. 2003. Seasonal patterns of invasive pneumococcal disease. Emerg. Infect. Dis. 9:573579.
58. Dugi, D. D., III, D. M. Musher, J. E. Clarridge III, and R. Kimbrough. 2001. Intraabdominal infection due to Streptococcus pneumoniae. Medicine 80:236244.
59. Dworkin, M. S.,, J. W. Ward,, D. L. Hanson,, J. L. Jones,, and J. E. Kaplan. 2001. Pneumococcal disease among human immunodeficiency virus-infected persons: incidence, risk factors, and impact of vaccination. Clin. Infect. Dis. 32:794800.
60. Ekdahl, K.,, I. Ahlinder,, H. B. Hansson,, E. Melander,, S. Molstad,, M. Soderstrom,, and K. Persson. 1997. Duration of nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae: experiences from the South Swedish Pneumococcal Intervention Project. Clin. Infect. Dis. 25:11131117.
61. Eljamel, M. S.,, and P. M. Foy. 1990. Acute traumatic CSF fistulae: the risk of intracranial infection. Br. J. Neurosurg. 4:381385.
62. Enright, M. C.,, and B. G. Spratt. 1998. A multilocus sequence typing scheme for Streptococcus pneumoniae: identification of clones associated with serious invasive disease. Microbiology 144:30493060.
63. Eraklis, A. J.,, S. V. Kevy,, L. K. Diamond,, and R. E. Gross. 1967. Hazard of overwhelming infection after splenectomy in childhood. N. Engl. J. Med. 276:12251229.
64. Eskola, J.,, T. Kilpi,, A. Palmu,, J. Jokinen,, J. Haapakoski,, E. Herva,, A. Takala,, H. Kayhty,, P. Karma,, R. Kohberger,, G. Siber,, and P. H. Makela. 2001. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N. Engl. J. Med. 344:403409.
65. Eskola, J.,, A. K. Takala,, E. Kela,, E. Pekkanen,, R. Kalliokoski,, and M. Leinonen. 1992. Epidemiology of invasive pneumococcal infections in children in Finland. JAMA 268:33233327.
66. Fainstein, V.,, D. M. Musher,, and T. R. Cate. 1980. Bacterial adherence to pharyngeal cells during viral infection. J. Infect. Dis. 141:172176.
67. Fang, G. D.,, M. Fine,, J. Orloff,, D. Arisumi,, V. L. Yu,, W. Kapoor,, J. T. Grayston,, S. P. Wang,, R. Kohler,, R. R. Muder,, Y. C. Yee,, J. D. Rihs,, and R. M. Vickers. 1990. New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases. Medicine 69:307316.
68. Feikin, D. R.,, and K. P. Klugman. 2002. Historical changes in pneumococcal serogroup distribution: implications for the era of pneumococcal conjugate vaccines. Clin. Infect. Dis. 35:547555.
69. Feikin, D. R.,, A. Schuchat,, M. Kolczak,, N. L. Barrett,, L. H. Harrison,, L. Lefkowitz,, A. McGeer,, M. M. Farley,, D. J. Vugia,, C. Lexau,, K. R. Stefonek,, J. E. Patterson,, and J. H. Jorgensen. 2000. Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997. Am. J. Public Health 90:223229.
70. Feldman, C.,, M. Glatthaar,, R. Morar,, A. G. Mahomed,, S. Kaka,, M. Cassel,, and K. P. Klugman. 1999. Bacteremic pneumococcal pneumonia in HIV-seropositive and HIV-seronegative adults. Chest 116:107114.
71. Finland, M.,, and M. W. Barnes. 1977. Acute bacterial meningitis at Boston City Hospital during 12 selected years, 1935-1972. J. Infect. Dis. 136:400415.
72. Finland, M.,, and M. W. Barnes. 1977. Changes in occurrence of capsular serotypes of Streptococcus pneumoniae at Boston City Hospital during selected years between 1935 and 1974. J. Clin. Microbiol. 5:154166.
73. Fiore, A. E.,, C. Iverson,, T. Messmer,, D. Erdman,, S. M. Lett,, D. F. Talkington,, L. J. Anderson,, B. Fields,, G. M. Carlone,, R. F. Breiman,, and M. S. Cetron. 1998. Outbreak of pneumonia in a long-term care facility: antecedent human parainfluenza virus 1 infection may predispose to bacterial pneumonia. J. Am. Geriatr. Soc. 46:11121117.
74. Frankel, R. E.,, M. Virata,, C. Hardalo,, F. L. Altice,, and G. Friedland. 1996. Invasive pneumococcal disease: clinical features, serotypes, and antimicrobial resistance patterns in cases involving patients with and without human immunodeficiency virus infection. Clin. Infect. Dis. 23:577584.
75. Fraser, D.,, N. Givon-Lavi,, N. Bilenko,, and R. Dagan. 2001. A decade (1989-1998) of pediatric invasive pneumococcal disease in 2 populations residing in 1 geographic location: implications for vaccine choice. Clin. Infect. Dis. 33:421427.
76. Fry, A. M.,, R. R. Facklam,, C. G. Whitney,, B. D. Plikaytis,, and A. Schuchat. 2003. Multistate evaluation of invasive pneumococcal diseases in adults with human immunodeficiency virus infection: serotype and antimicrobial resistance paterns in the United States. J. Infect. Dis. 188:643652.
77. Garcia-Leoni, M. E.,, S. Moreno,, P. Rodeno,, E. Cercenado,, T. Vicente,, and E. Bouza. 1992. Pneumococcal pneumonia in adult hospitalized patients infected with the human immunodeficiency virus. Arch. Intern. Med. 152:18081812.
78. Gebo, K. A.,, R. D. Moore,, J. C. Keruly,, and R. E. Chaisson. 1996. Risk factors for pneumococcal disease in human immunodeficiency virusinfected patients. J. Infect. Dis. 173:857862.
79. Gertz, R. E., Jr., M. C. McEllistrem, D. J. Boxrud, Z. Li, V. Sakota, T. A. Thompson, R. R. Facklam, J. M. Besser, L. H. Harrison, C. G. Whitney, and B. Beall. 2003. Clonal distribution of invasive pneumococcal isolates from children and selected adults in the United States prior to 7-valent conjugate vaccine introduction. J. Clin. Microbiol. 41:41944216.
80. Gessner, B. D.,, X. T. Ussery,, A. J. Parkinson,, and R. F. Breiman. 1995. Risk factors for invasive disease caused by Streptococcus pneumoniae among Alaska Native children younger than two years of age. Pediatr. Infect. Dis. J. 14:123128.
81. Giglio, M. S.,, M. Landaeta,, and M. E. Pinto. 1997. Microbiology of recurrent parotitis. Pediatr. Infect. Dis. J. 16:386390.
82. Givner, L. B.,, E. O. Mason, Jr.,, W. J. Barson,, T. Q. Tan,, E. R. Wald,, G. E. Schutze,, K. S. Kim,, J. S. Bradley,, R. Yogev,, and S. L. Kaplan. 2000. Pneumococcal facial cellulitis in children. Pediatrics 106:e61.
83. Gleich, S.,, Y. Morad,, R. Echague,, J. R. Miller,, J. Kornblum,, J. S. Sampson,, and J. C. Butler. 2000. Streptococcus pneumoniae serotype 4 outbreak in a home for the aged: report and review of recent outbreaks. Infect. Control Hosp. Epidemiol. 21:711717.
84. Gomez, M.,, S. Alter,, M. L. Kumar,, S. Murphy,, and M. H. Rathore. 1999. Neonatal Streptococcus pneumoniae infection: case reports and review of the literature. Pediatr. Infect. Dis. J. 18:10141018.
85. Gopal, V.,, and A. L. Bisno. 1977. Fulminant pneumococcal infections in ‘normal’ asplenic hosts. Arch. Intern. Med. 137:15261530.
86. Gratten, M.,, F. Morey,, J. Dixon,, K. Manning,, P. Torzillo,, R. Matters,, J. Erlich,, J. Hanna,, V. Asche,, and I. Riley. 1993. An outbreak of serotype 1 Streptococcus pneumoniae infection in central Australia. Med. J. Aust. 158:340342.
87. Gratten, M.,, P. Torzillo,, F. Morey,, J. Dixon,, J. Erlich,, J. Hagger,, and J. Henrichsen. 1996. Distribution of capsular types and antibiotic susceptibility of invasive Streptococcus pneumoniae isolated from Aborigines in central Australia. J. Clin. Microbiol. 34:338341.
88. Gray, B. M. 2001. Is pneumococcal hemolyticuremic syndrome a new disease? Infect. Med. 18:251258.
89. Gray, B. M.,, G. M. Converse III,, and H. C. Dillon, Jr. 1980. Epidemiologic studies of Streptococcus pneumoniae in infants: acquisition, carriage, and infection during the first 24 months of life. J. Infect. Dis. 142:923933.
90. Gray, B. M.,, G. M. Converse III,, and H. C. Dillon, Jr. 1979. Serotypes of Streptococcus pneumoniae causing disease. J. Infect. Dis. 140:979983.
91. Gray, B. M.,, and H. C. Dillon, Jr. 1988. Epidemiological studies of Streptococcus pneumoniae in infants: antibody to types 3, 6, 14, and 23 in the first two years of life. J. Infect. Dis. 158:948955.
92. Gray, G. C.,, J. D. Callahan,, A. W. Hawksworth,, C. A. Fisher,, and J. C. Gaydos. 1999. Respiratory diseases among U.S. military personnel: countering emerging threats. Emerg. Infect. Dis. 5:379385.
93. Grigoriadis, E.,, and W. L. Gold. 1997. Pyogenic brain abscess caused by Streptococcus pneumoniae:case report and review. Clin. Infect. Dis. 25:11081112.
94. Guevara, R. E.,, J. C. Butler,, B. J. Marston,, J. F. Plouffe,, T. M. File, Jr., and R. F. Breiman. 1999. Accuracy of ICD-9-CM codes in detecting community-acquired pneumococcal pneumonia for incidence and vaccine efficacy studies. Am. J. Epidemiol. 149:282289.
95. Gwaltney, J. M., Jr., M. A. Sande, R. Austrian, and J. O. Hendley. 1975. Spread of Streptococcus pneumoniae in families. II. Relation of transfer of S. pneumoniae to incidence of colds and serum antibody. J. Infect. Dis. 132:6268.
96. Harrison, L. H.,, D. M. Dwyer,, L. Billmann,, M. S. Kolczak,, and A. Schuchat. 2000. Invasive pneumococcal infection in Baltimore, MD: implications for immunization policy. Arch. Intern. Med. 160:8994.
97. Hausdorff, W. P.,, J. Bryant,, C. Kloek,, P. R. Paradiso,, and G. R. Siber. 2000. The contribution of specific pneumococcal serogroups to different disease manifestations: implications for conjugate vaccine formulation and use, part II. Clin. Infect. Dis. 30:122140.
98. Hausdorff, W. P.,, J. Bryant,, P. R. Paradiso,, and G. R. Siber. 2000. Which pneumococcal serogroups cause the most invasive disease: implications for conjugate vaccine formulation and use, part I. Clin. Infect. Dis. 30:100121.
99. Hausdorff, W. P.,, G. Siber,, and P. R. Paradiso. 2001. Geographical differences in invasive pneumococcal disease rates and serotype frequency in young children. Lancet 357:950952.
100. Hausdorff, W. P.,, G. Yothers,, R. Dagan,, T. Kilpi,, S. I. Pelton,, R. Cohen,, M. R. Jacobs,, S. L. Kaplan,, C. Levy,, E. L. Lopez,, E. O. Mason, Jr., V. Syriopoulou, B. Wynne, and J. Bryant. 2002. Multinational study of pneumococcal serotypes causing acute otitis media in children. Pediatr. Infect. Dis. J. 21:10081016.
101. Heikkinen, T.,, and T. Chonmaitree. 2003. Importance of respiratory viruses in acute otitis media. Clin. Microbiol. Rev. 16:230241.
102. Hendley, J. O.,, M. A. Sande,, P. M. Stewart,, and J. M. Gwaltney, Jr. 1975. Spread of Streptococcus pneumoniae in families. I. Carriage rates and distribution of types. J. Infect. Dis. 132:5561.
103. Henrichsen, J. 1995. Six newly recognized types of Streptococcus pneumoniae. J. Clin. Microbiol. 33:27592762.
104. Henrichsen, J. 1999. Typing of Streptococcus pneumoniae: past, present, and future. Am. J. Med. 107:50S54S.
105. Henriques Normark, B.,, M. Kalin,, A. Ortqvist,, T. Akerlund,, B. O. Liljequist,, J. Hedlund,, S. B. Svenson,, J. Zhou,, B. G. Spratt,, S. Normark,, and G. Kallenius. 2001. Dynamics of penicillin-susceptible clones in invasive pneumococcal disease. J. Infect. Dis. 184:861869.
106. Hermans, P. W.,, M. Sluijter,, S. Dejsirilert,, N. Lemmens,, K. Elzenaar,, A. van Veen,, W. H. Goessens,, and R. de Groot. 1997. Molecular epidemiology of drug-resistant pneumococci:toward an international approach. Microb. Drug Resist. 3:243251.
107. Hermans, P. W.,, M. Sluijter,, T. Hoogenboezem,, H. Heersma,, A. van Belkum,, and R. de Groot. 1995. Comparative study of five different DNA fingerprint techniques for molecular typing of Streptococcus pneumoniae strains. J. Clin. Microbiol. 33:16061612.
108. High, K. P. 2002. Infection in an ageing world. Lancet Infect. Dis. 2:655.
109. Hirsch, E. F.,, and M. McKinney. 1919. An epidemic of pneumococcus bronchopneumonia. J. Infect. Dis. 24:594617.
110. Hodges, R.,, and C. MacLeod. 1946. Epidemic pneumococcal pneumonia. V. Final considerations of the factors underlying the epidemic. Am. J. Hyg. 44:237243.
111. Hoge, C. W.,, M. R. Reichler,, E. A. Dominguez,, J. C. Bremer,, T. D. Mastro,, K. A. Hendricks,, D. M. Musher,, J. A. Elliott,, R. R. Facklam,, and R. F. Breiman. 1994. An epidemic of pneumococcal disease in an overcrowded, inadequately ventilated jail. N. Engl. J. Med. 331:643648.
112. Holle, H. A.,, and J. G. M. Bullowa. 1940. Pneumococcal cross-infection in the home and hospital. N. Engl. J. Med. 223:887890.
113. Janoff, E. N.,, R. F. Breiman,, C. L. Daley,, and P. C. Hopewell. 1992. Pneumococcal disease during HIV infection. Epidemiologic, clinical, and immunologic perspectives. Ann. Intern. Med. 117:314324.
114. Janoff, E. N.,, J. O’Brien,, P. Thompson,, J. Ehret,, G. Meiklejohn,, G. Duvall,, and J. M. Douglas, Jr. 1993. Streptococcus pneumoniae colonization, bacteremia, and immune response among persons with human immunodeficiency virus infection. J. Infect. Dis. 167:4956.
115. Joloba, M. L.,, A. Windau,, S. Bajaksouzian,, P. C. Appelbaum,, W. P. Hausdorff,, and M. R. Jacobs. 2001. Pneumococcal conjugate vaccine serotypes of Streptococcus pneumoniae isolates and the antimicrobial susceptibility of such isolates in children with otitis media. Clin. Infect. Dis. 33:14891494.
116. Jones, N.,, R. Huebner,, M. Khoosal,, H. Crewe-Brown,, and K. Klugman. 1998. The impact of HIV on Streptococcus pneumoniae bacteraemia in a South African population. AIDS 12:21772184.
117. Kamerling, J. P., 2000. Pneumococcal polysaccharides:a chemical view, p. 81114. In A. Tomasz (ed.), Streptococcus pneumoniae: Molecular Biology and Mechanisms of Disease. Mary Anne Liebert, Inc., Larchmont, N.Y..
118. Kaplan, S. L.,, E. O. Mason, Jr.,, E. R. Wald,, K. S. Kim,, L. B. Givner,, J. S. Bradley,, W. J. Barson,, T. Q. Tan,, G. E. Schutze,, and R. Yogev. 2000. Pneumococcal mastoiditis in children. Pediatrics 106:695699.
119. Kauffman, C. A.,, C. Watanakunakorn,, and J. P. Phair. 1973. Purulent pneumococcal pericarditis. A continuing problem in the antibiotic era. Am. J. Med. 54:743750.
120. Kessler, H. A.,, R. Schade,, G. M. Trenholme,, J. E. Jupa,, and S. Levin. 1980. Acute pneumococcal epiglottitis in immunocompromised adults. Scand. J. Infect. Dis. 12:207210.
121. Kim, P. E.,, D. M. Musher,, W. P. Glezen,, M. C. Rodriguez-Barradas,, W. K. Nahm,, and C. E. Wright. 1996. Association of invasive pneumococcal disease with season, atmospheric conditions, air pollution, and the isolation of respiratory viruses. Clin. Infect. Dis. 22:100106.
122. Klein, J. O. 1981. The epidemiology of pneumococcal disease in infants and children. Rev. Infect. Dis. 3:246253.
123. Koeuth, T.,, J. Versalovic,, and J. R. Lupski. 1995. Differential subsequence conservation of interspersed repetitive Streptococcus pneumoniae BOX elements in diverse bacteria. Genome Res. 5:408418.
124. Kutas, L. M.,, J. M. Duggan,, and C. A. Kauffman. 1995. Pneumococcal vertebral osteomyelitis. Clin. Infect. Dis. 20:286290.
125. Lau, G. W.,, S. Haataja,, M. Lonetto,, S. E. Kensit,, A. Marra,, A. P. Bryant,, D. McDevitt,, D. A. Morrison,, and D. W. Holden. 2001. A functional genomic analysis of type 3 Streptococcus pneumoniae virulence. Mol. Microbiol. 40:555571.
126. Lefevre, J. C.,, G. Faucon,, A. M. Sicard,, and A. M. Gasc. 1993. DNA fingerprinting of Streptococcus pneumoniae strains by pulsedfield gel electrophoresis. J. Clin. Microbiol. 31:27242728.
127. Leino, T.,, K. Auranen,, J. Jokinen,, M. Leinonen,, P. Tervonen,, and A. K. Takala. 2001. Pneumococcal carriage in children during their first two years: important role of family exposure. Pediatr. Infect. Dis. J. 20:10221027.
128. Levine, O. S.,, M. Farley,, L. H. Harrison,, L. Lefkowitz,, A. McGeer,, and B. Schwartz. 1999. Risk factors for invasive pneumococcal disease in children: a population-based case-control study in North America. Pediatrics 103:e28.
129. Lew, D.,, H. Hausler,, F. Southwick,, and A. Baker. 1984. Sphenoid sinusitis. Biomed. Pharmacother. 38:214216.
130. Linnemann, C. C., Jr., and M. R. First. 1979. Risk of pneumococcal infections in renal transplant patients. JAMA 241:26192621.
131. Lipsky, B. A.,, E. J. Boyko,, T. S. Inui,, and T. D. Koepsell. 1986. Risk factors for acquiring pneumococcal infections. Arch. Intern. Med. 146:21792185.
132. Lloyd-Evans, N.,, T. J. O’Dempsey,, I. Baldeh,, O. Secka,, E. Demba,, J. E. Todd,, T. F. McArdle,, W. S. Banya,, and B. M. Greenwood. 1996. Nasopharyngeal carriage of pneumococci in Gambian children and in their families. Pediatr. Infect. Dis. J. 15:866871.
133. Loda, F. A.,, A. M. Collier,, W. P. Glezen,, K. Strangert,, W. A. Clyde,, and F. W. Denny. 1975. Occurrence of Diplococcus pneumoniae in the upper respiratory tract of children. J. Pediatr. 87:10871093.
134. Mao, C.,, M. Harper,, K. McIntosh,, C. Reddington,, J. Cohen,, R. Bachur,, B. Caldwell,, and H. W. Hsu. 1996. Invasive pneumococcal infections in human immunodeficiency virus-infected children. J. Infect. Dis. 173:870876.
135.. Marrie, T. J., 2001. Etiology of community-acquired pneumonia, p. 131141. In T. J. Marrie (ed.), Community-Acquired Pneumonia. Plenum Publishers, New York, N.Y..
136. Marston, B. J.,, J. F. Plouffe,, T. M. File, Jr., B. A. Hackman, S. J. Salstrom, H. B. Lipman, M. S. Kolczak, and R. F. Breiman. 1997. Incidence of community-acquired pneumonia requiring hospitalization. Results of a population-based active surveillance study in Ohio. Arch. Intern. Med. 157:17091718.
137. Martin, M.,, J. H. Turco,, M. E. Zegans,, R. R. Facklam,, S. Sodha,, J. A. Elliott,, J. H. Pryor,, B. Beall,, D. D. Erdman,, Y. Y. Baumgartner,, P. A. Sanchez,, J. D. Schwartzman,, J. Montero,, A. Schuchat,, and C. G. Whitney. 2003. An outbreak of conjunctivitis due to atypical Streptococcus pneumoniae. N. Engl. J. Med. 348:11121121.
138. McEllistrem, M. C.,, A. B. Mendelsohn,, M. A. Pass,, J. A. Elliott,, C. G. Whitney,, J. A. Kolano,, and L. H. Harrison. 2002. Recurrent invasive pneumococcal disease in individuals with human immunodeficiency virus infection. J. Infect. Dis. 185:13641368.
139. McGee, L.,, K. P. Klugman,, and A. Tomasz,. 2000. Serotypes and clones of antibiotic-resistant pneumococci. In A. Tomasz (ed.), Streptococcus pneumoniae: Molecular Biology and Mechanism of Disease. Mary Ann Liebert, Inc., Larchmont, N.Y..
140. McGee, L.,, L. McDougal,, J. Zhou,, B. G. Spratt,, F. C. Tenover,, R. George,, R. Hakenbeck,, W. Hryniewicz,, J. C. Lefevre,, A. Tomasz,, and K. P. Klugman. 2001. Nomenclature of major antimicrobial-resistant clones of Streptococcus pneumoniae defined by the pneumococcal molecular epidemiology network. J. Clin. Microbiol. 39:25652571.
141. Mercat, A.,, J. Nguyen,, and B. Dautzenberg. 1991. An outbreak of pneumococcal pneumonia in two men’s shelters. Chest 99:147151.
142. Miller, J. L.,, and F. B. Lusk. 1918. Epidemic of streptococcal pneumonia and empyema at Camp Dodge, Iowa. JAMA 71:702704.
143. Mufson, M. A. 1981. Pneumococcal infections. JAMA 246:19421948.
144. Mulhern, M. G.,, P. I. Condon,, and M. O’Keefe. 1997. Endophthalmitis after astigmatic myopic laser in situ keratomileusis. J. Cataract Refract. Surg. 23:948950.
145. Musher, D. M. 2003. How contagious are common respiratory tract infections? N. Engl. J. Med. 348:12561266.
146. Musher, D. M. 1992. Infections cause by Streptococcus pneumoniae: clinical spectrum, pathogenesis, immunity, and treatment. Clin. Infect. Dis. 14:801809.
147. Musher, D. M.,, J. E. Groover,, M. R. Reichler,, F. X. Riedo,, B. Schwartz,, D. A. Watson,, R. E. Baughn,, and R. F. Breiman. 1997. Emergence of antibody to capsular polysaccharides of Streptococcus pneumoniae during outbreaks of pneumonia: association with nasopharyngeal colonization. Clin. Infect. Dis. 24:441446.
148. Musher, D. M.,, H. M. Phan,, D. A. Watson,, and R. E. Baughn. 2000. Antibody to capsular polysaccharide of Streptococcus pneumoniae at the time of hospital admission for pneumococcal pneumonia. J. Infect. Dis. 182:158167.
149. Myers, K. A.,, and T. J. Marrie. 1993. Thrombotic microangiopathy associated with Streptococcus pneumoniae bacteremia: case report and review. Clin. Infect. Dis. 17:10371040.
150. Naktin, J.,, and J. DeSimone. 1999. Lumbar vertebral osteomyelitis with mycotic abdominal aortic aneurysm caused by highly penicillin-resistant Streptococcus pneumoniae. J. Clin. Microbiol. 37:41984200.
151. Notter, D. T.,, P. L. Grossman,, S. A. Rosenberg,, and J. S. Remington. 1980. Infections in patients with Hodgkin’s disease: a clinical study of 300 consecutive adult patients. Rev. Infect. Dis. 2:761800.
152. Nuorti, J. P.,, J. C. Butler,, J. M. Crutcher,, R. Guevara,, D. Welch,, P. Holder,, and J. A. Elliott. 1998. An outbreak of multidrug-resistant pneumococcal pneumonia and bacteremia among unvaccinated nursing home residents. N. Engl. J. Med. 338:18611868.
153. Nuorti, J. P.,, J. C. Butler,, M. M. Farley,, L. H. Harrison,, A. McGeer,, M. S. Kolczak,, and R. F. Breiman. 2000. Cigarette smoking and invasive pneumococcal disease. N. Engl. J. Med. 342:681689.
154. Nuorti, J. P.,, J. C. Butler,, L. Gelling,, J. L. Kool,, A. L. Reingold,, and D. J. Vugia. 2000. Epidemiologic relation between HIV and invasive pneumococcal disease in San Francisco County, California. Ann. Intern. Med. 132:182190.
155. O’Brien, K. L.,, M. I. Walters,, J. Sellman,, P. Quinlisk,, H. Regnery,, B. Schwartz,, and S. F. Dowell. 2000. Severe pneumococcal pneumonia in previously healthy children: the role of preceding influenza infection. Clin. Infect. Dis. 30:784789.
156. Pantosti, A.,, G. Gherardi,, M. Conte,, F. Faella,, G. Dicuonzo,, and B. Beall. 2002. A novel, multiple drug-resistant, serotype 24F strain of Streptococcus pneumoniae that caused meningitis in patients in Naples, Italy. Clin. Infect. Dis. 35:205208.
157. Park, J. H., Jr., and H. T. Chickering. 1919. Type I pneumococcal lobal pneumonia among Puerto Rican laborers of Camp Jackson, South Carolina. JAMA 73:183186.
158. Pastor, P.,, F. Medley,, and T. V. Murphy. 1998. Invasive pneumococcal disease in Dallas County, Texas: results from populationbased surveillance in 1995. Clin. Infect. Dis. 26:590595.
159. Piccioli, A.,, G. Chini,, M. Mannelli,, and M. Serio. 1994. Bilateral massive adrenal hemorrhage due to sepsis: report of two cases. J. Endocrinol. Investig. 17:821824.
160. Plouffe, J. F.,, R. F. Breiman,, R. R. Facklam, and the Franklin County Pneumonia Study Group. 1996. Bacteremia with Streptococcus pneumoniae. Implications for therapy and prevention. JAMA 275:194198.
161. Polissi, A.,, A. Pontiggia,, G. Feger,, M. Altieri,, H. Mottl,, L. Ferrari,, and D. Simon. 1998. Large-scale identification of virulence genes from Streptococcus pneumoniae. Infect. Immun. 66:56205629.
162. Proulx, J. F.,, S. Dery,, L. P. Jette,, J. Ismael,, M. Libman,, and P. De Wals. 2002. Pneumonia epidemic caused by a virulent strain of Streptococcus pneumoniae serotype 1 in Nunavik, Quebec. Canada Communicable Dis. Rep. 28:129131.
163. Rauch, A. M.,, M. O’Ryan,, R. Van,, and L. K. Pickering. 1990. Invasive disease due to multiply resistant Streptococcus pneumoniae in a Houston, Tex., day-care center. Am. J. Dis. Child. 144:923927.
164. Redd, S. C.,, G. W. Rutherford III,, M. A. Sande,, A. R. Lifson,, W. K. Hadley,, R. R. Facklam,, and J. S. Spika. 1990. The role of human immunodeficiency virus infection in pneumococcal bacteremia in San Francisco residents. J. Infect. Dis. 162:10121017.
165. Reefhuis, J.,, M. A. Honein,, C. G. Whitney,, S. Chamany,, E. A. Mann,, K. R. Biernath,, K. Broder,, S. Manning,, S. Avashia,, M. Victor,, P. Costa,, O. Devine,, A. Graham,, and C. Boyle. 2003. Risk of bacterial meningitis in children with cochlear implants. N. Engl. J. Med. 349:435445.
166. Richter, S. S.,, K. P. Heilmann,, S. L. Coffman,, H. K. Huynh,, A. B. Brueggemann,, M. A. Pfaller,, and G. V. Doern. 2002. The molecular epidemiology of penicillin-resistant Streptococcus pneumoniae in the United States, 1994-2000. Clin. Infect. Dis. 34:330339.
167. Robinson, D. A.,, D. E. Briles,, M. J. Crain,, and S. K. Hollingshead. 2002. Evolution and virulence of serogroup 6 pneumococci on a global scale. J. Bacteriol. 184:63676375.
168. Robinson, K. A.,, W. Baughman,, G. Rothrock,, N. L. Barrett,, M. Pass,, C. Lexau,, B. Damaske,, K. Stefonek,, B. Barnes,, J. Patterson,, E. R. Zell,, A. Schuchat,, and C. G. Whitney. 2001. Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995-1998: opportunities for prevention in the conjugate vaccine era. JAMA 285:17291735.
169. Robinson, M. G.,, and R. J. Watson. 1966. Pneumococcal meningitis in sickle-cell anemia. N. Engl. J. Med. 274:10061008.
170. Ross, J. J.,, C. L. Saltzman,, P. Carling,, and D. S. Shapiro. 2003. Pneumococcal septic arthritis: review of 190 cases. Clin. Infect. Dis. 36:319327.
171. Rudolph, K. M.,, A. J. Parkinson,, A. L. Reasonover,, L. R. Bulkow,, D. J. Parks,, and J. C. Butler. 2000. Serotype distribution and antimicrobial resistance patterns of invasive isolates of Streptococcus pneumoniae: Alaska, 1991-1998. J. Infect. Dis. 182:490496.
172. Saenz, R. E.,, C. V. Sanders,, K. E. Aldridge,, and M. M. Patel. 1998. Purulent pericarditis with associated cardiac tamponade caused by a Streptococcus pneumoniae strain highly resistant to penicillin, cefotaxime, and ceftriaxone. Clin. Infect. Dis. 26:762763.
173. Schonheyder, H. C.,, H. T. Sorensen,, B. Kristensen,, and B. Korsager. 1997. Reasons for increase in pneumococcal bacteraemia. Lancet 349:1554.
174. Schuchat, A.,, K. Robinson,, J. D. Wenger,, L. H. Harrison,, M. Farley,, A. L. Reingold,, L. Lefkowitz,, and B. A. Perkins. 1997. Bacterial meningitis in the United States in 1995. N. Engl. J. Med. 337:970976.
175. Schwarzmann, S. W.,, J. L. Adler,, R. J. Sullivan, Jr.,, and W. M. Marine. 1971. Bacterial pneumonia during the Hong Kong influenza epidemic of 1968-1969. Arch. Intern. Med. 127:10371041.
176. Scott, J. A.,, A. J. Hall,, R. Dagan,, J. M. Dixon,, S. J. Eykyn,, A. Fenoll,, M. Hortal,, L. P. Jette,, J. H. Jorgensen,, F. Lamothe,, C. Latorre,, J. T. Macfarlane,, D. M. Shlaes,, L. E. Smart,, and A. Taunay. 1996. Serogroupspecific epidemiology of Streptococcus pneumoniae: associations with age, sex, and geography in 7,000 episodes of invasive disease. Clin. Infect. Dis. 22:973981.
177. Sheppard, D. C.,, K. A. Bartlett,, and H. W. Lampiris. 1998. Streptococcus pneumoniae transmission in chronic-care facilities: description of an outbreak and review of management strategies. Infect. Control Hosp. Epidemiol. 19:851853.
178. Shimada, J.,, N. Yamanaka,, M. Hotomi,, M. Suzumoto,, A. Sakai,, K. Ubukata,, T. Mitsuda,, S. Yokota,, and H. Faden. 2002. Household transmission of Streptococcus pneumoniae among siblings with acute otitis media. J. Clin. Microbiol. 40:18511853.
179. Simolte, S.,, E. Smith,, and D. M. Musher. 1996. Waterhouse-Friderichsen syndrome due to Streptococcus pneumoniae in an otherwise health adult. Infect. Dis. Clin. Pract. 5:398400.
180. Sirotnak, A. P.,, S. C. Eppes,, and J. D. Klein. 1996. Tuboovarian abscess and peritonitis caused by Streptococcus pneumoniae serotype 1 in young girls. Clin. Infect. Dis. 22:993996.
181. Sleeman, K.,, K. Knox,, R. George,, E. Miller,, P. Waight,, D. Griffiths,, A. Efstratiou,, K. Broughton,, R. T. Mayon-White,, E. R. Moxon,, and D. W. Crook. 2001. Invasive pneumococcal disease in England and Wales: vaccination implications. J. Infect. Dis. 183:239246.
182. Smillie, W. G. 1936. A study of an outbreak of type II pneumococcus pneumonia in the Veterans’ Administration hospital at Bedford, Massachusetts. Am. J. Hyg. 24:522535.
183. Smillie, W. G.,, G. Warnock,, and H. White. 1938. Study of a type I pneumococcus epidemic at the State Hospital at Worcester, Massachusetts. Am. J. Public Health 28:293302.
184. Smith, A. M.,, K. P. Klugman,, T. J. Coffey,, and B. G. Spratt. 1993. Genetic diversity of penicillin-binding protein 2B and 2X genes from Streptococcus pneumoniae in South Africa. Antimicrob. Agents Chemother. 37:19381944.
185. Sniadack, D. H.,, B. Schwartz,, H. Lipman,, J. Bogaerts,, J. C. Butler,, R. Dagan,, G. Echaniz-Aviles,, N. Lloyd-Evans,, A. Fenoll,, N. I. Girgis,, J. Henrichsen,, K. Klugman,, D. Lehmann,, A. K. Takala,, J. Vandepitte,, S. Gove,, and R. F. Breiman. 1995. Potential interventions for the prevention of childhood pneumonia: geographic and temporal differences in serotype and serogroup distribution of sterile site pneumococcal isolates from children—implications for vaccine strategies. Pediatr. Infect. Dis. J. 14:503510.
186. Spataro, V.,, and C. Marone. 1993. Rhabdomyolysis associated with bacteremia due to Streptococcus pneumoniae: case report and review. Clin. Infect. Dis. 17:10631064.
187. Stillman, E. G. 1917. Further studies on the epidemiology of lobar pneumonia. J. Exp. Med. 26:513535.
188. Subramanian, D.,, J. A. Sandoe,, V. Keer,, and M. H. Wilcox. 2003. Rapid spread of penicillin-resistant Streptococcus pneumoniae among high-risk hospital inpatients and the role of molecular typing in outbreak confirmation. J. Hosp. Infect. 54:99103.
189. Takala, A. K.,, J. Jero,, E. Kela,, P. R. Ronnberg,, E. Koskenniemi,, and J. Eskola. 1995. Risk factors for primary invasive pneumococcal disease among children in Finland. JAMA 273:859864.
190. Taylor, S. N.,, and C. V. Sanders. 1999. Unusual manifestations of invasive pneumococcal infection. Am. J. Med. 107:12S27S.
191. Tenny, C. F.,, and W. T. Riverburgh. 1919. A group of 68 cases of type I pneumonia occurring in 30 days at Camp Upton. Arch. Intern. Med. 24:545552.
192. Thompson, R. T.,, J. M. Ruegsegger,, M. A. Blankenhorn,, and M. Hamburger. 1951. Primary pneumococcic pneumonia at the Cincinnati General Hospital, 1936-1950. J. Lab. Clin. Med. 37:7387.
193. Tilghman, F. C.,, and M. Finland. 1937. Clinical significance of bacteremia in pneumococcal pneumonia. Arch. Intern. Med. 59:602619.
194. Tilghman, F. C.,, and M. Finland. 1936. Pneumococcic infections in families. J. Clin. Investig. 15:493499.
195. Torzillo, P. J.,, J. N. Hanna,, F. Morey,, M. Gratten,, J. Dixon,, and J. Erlich. 1995. Invasive pneumococcal disease in central Australia. Med. J. Aust. 162:182186.
196. Trotman, J.,, B. Hughes,, and L. Mollison. 1995. Invasive pneumococcal disease in central Australia. Clin. Infect. Dis. 20:15531556.
197. Twomey, J. J. 1973. Infections complicating multiple myeloma and chronic lymphocytic leukemia. Arch. Intern. Med. 132:562565.
198. van Belkum, A.,, M. Sluijuter,, R. de Groot,, H. Verbrugh,, and P. W. Hermans. 1996. Novel BOX repeat PCR assay for high-resolution typing of Streptococcus pneumoniae strains. J. Clin. Microbiol. 34:11761179.
199. Wadowsky, R. M.,, S. M. Mietzner,, D. P. Skoner,, W. J. Doyle,, and P. Fireman. 1995. Effect of experimental influenza A virus infection on isolation of Streptococcus pneumoniae and other aerobic bacteria from the oropharynges of allergic and nonallergic adult subjects. Infect. Immun. 63:11531157.
200. Wald, E. R. 1992. Sinusitis in children. N. Engl. J. Med. 326:319323.
201. Wald, E. R.,, G. J. Milmoe,, A. Bowen,, J. Ledesma-Medina,, N. Salamon,, and C. D. Bluestone. 1981. Acute maxillary sinusitis in children. N. Engl. J. Med. 304:749754.
202. Weisholtz, S. J.,, B. J. Hartman,, and R. B. Roberts. 1983. Effect of underlying disease and age on pneumococcal serotype distribution. Am. J. Med. 75:199205.
203. Westh, H.,, L. Skibsted,, and B. Korner. 1990. Streptococcus pneumoniae infections of the female genital tract and in the newborn child. Rev. Infect. Dis. 12:416422.
204. Whitecar, J. P., Jr.,, J. L. Reddin,, and W. W. Spink. 1966. Recurrent pneumococcal meningitis: a review of the literature and studies on a patient who recovered from eleven attacks caused by five serotypes of Diplococcus pneumoniae. N. Engl. J. Med. 274:12851289.
205. Whitney, C. G.,, M. M. Farley,, J. Hadler,, L. H. Harrison,, N. M. Bennett,, R. Lynfield,, A. Reingold,, P. R. Cieslak,, T. Pilishvili,, D. Jackson,, R. R. Facklam,, J. H. Jorgensen,, A. Schuchat, and Active Bacterial Core Surveillance of the Emerging Infections Program Network. 2003. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N. Engl. J. Med. 348:17371746.
206. Winston, D. J.,, G. Schiffman,, D. C. Wang,, S. A. Feig,, C. H. Lin,, E. L. Marso,, W. G. Ho,, L. S. Young,, and R. P. Gale. 1979. Pneumococcal infections after human bone-marrow transplantation. Ann. Intern. Med. 91:835841.
207. Zangwill, K. M.,, C. M. Vadheim,, A. M. Vannier,, L. S. Hemenway,, D. P. Greenberg,, and J. I. Ward. 1996. Epidemiology of invasive pneumococcal disease in southern California: implications for the design and conduct of a pneumococcal conjugate vaccine efficacy trial. J. Infect. Dis. 174:752759.

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