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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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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