Purpose of Study In 2001, the State of Alaska began routine use of the infant heptavalent pneumococcal vaccine (PCV7; Prevnar). This has resulted in a 90% decline in vaccine-type invasive pneumococcal disease (IPD) in children < 5 years old. We sought to determine the indirect effects of PCV7 through changes in IPD and colonization in non-vaccinated Alaskans 55 years and older.
Methods Used We used statewide surveillance to compare IPD rates, pneumococcal serotypes, and antimicrobial resistance before (1995-2000) and after (2002-2004) widespread PCV7 use. Colonization data, before (1998-2000) and after (2002-2004) PCV7 use, was obtained from community-wide pneumococcal colonization study in eight rural Alaska villages. Summary of
Results In the post vaccine time period, annual IPD rates declined by 22% for persons over age 55, from 47.0 cases/100,000 to 36.6 cases/100,000 (p = .04). IPD caused by PCV7 serotypes declined by 60% in this group (rate = 19.0/100,000 pre-vaccine and 7.6 in the post-vaccine time period p < .001). IPD complicated with serotypes non-susceptible to cefotaxime declined by 100% in the post-vaccine era (p = .006). Resistance to penicillin, erythromycin, tetracycline, and trimethoprim-sulfomethoxazole among cases of IPD remained the same. Villagers in the colonization study demonstrated a 41.8% increase in colonization by non-PCV7 serotypes in the post-vaccine time period (p = .006), with a 4.08 times reduced risk of being colonized by PCV7 serotypes (95% CI = 1.45-11.50; p = .01).
Conclusion Pediatric PCV7 use has been associated with reductions in IPD due to PCV7 serotypes, infections complicated with cefotaxime, as well as reduced PCV7 serotype colonization in Alaskans 55 and older.
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