This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Margaret Mary Cortese, MD; Mark Wolff, PhD; Janné Almeido-Hill; Raymond Reid, MD; Jeffrey Ketcham, MD; Mathuram Santosham, MD, MPH

Arch Intern Med. 1992;152(11):2277-2282.

Abstract
• Objective.—
In this article we determine the incidence and clinical spectrum of invasive pneumococcal disease in the White Mountain Apache population, a group known to have a high incidence of invasive disease due to Haemophilus influenzae type b.

Design.—
Patients from whom cultures of normally sterile body sites yielded Streptococcus pneumoniae were identified retrospectively through review of hospital laboratory records from a 6.8-year period. Clinical data were reviewed and incidence rates were computed.

Setting.—
The Whiteriver Indian Health Service Hospital is located on the 1.7-million-acre White Mountain Apache Reservation in eastern Arizona.

Patients.—
Approximately 10 000 members of the White Mountain Apache Tribe reside on or near the reservation and receive health care through the Whiteriver Indian Health Service Hospital.

Outcome Measures.—
The average annual incidence rates of invasive pneumococcal disease were calculated and clinical characteristics were reviewed.

Results.—
One hundred thirty-eight cases of invasive pneumococcal disease were identified. The average annual incidence rate was 207 per 100 000 population, and 156 per 100 000 population when adjusted for age by direct standardization to the 1988 US population. The incidence rate was highest in children between 1 and 2 years—2396 per 100000. The overall case-fatality rate was 5%. Pneumococcal pneumonia was the diagnosis in 79% of the patients 5 years of age or older. Alcohol abuse, identified in 66% of the cases in adults, was the most common underlying medical condition.

Conclusion.—
The incidence rates in White Mountain Apaches are the highest reported for any population. A vaccine effective in children would greatly benefit this population.

(Arch Intern Med. 1992;152:2277-2282)

Author Affiliations
From the Center for American Indian and Alaskan Native Health, Department of International Health (Drs Cortese, Wolff, Almeido-Hill, Reid, and Santosham) and the Division of Pediatric Infectious Disease, Department of Pediatrics (Dr Santosham), The Johns Hopkins University School of Hygiene and Public Health and the School of Medicine, Baltimore, Md; and The Indian Health Service, Whiteriver, Ariz (Dr Ketcham).

Footnotes
Accepted for publication April 10, 1992.

The opinions in this article are those of the authors and do not necessarily reflect the views of the Indian Health Service.

Reprint requests to the Center for American Indian and Alaskan Native Health, Department of International Health, The Johns Hopkins University School of Hygiene and Public Health, 615 N Wolfe St, Baltimore, MD 21205 (Dr Santosham).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Impact of Immunizations on the Disease Burden of American Indian and Alaska Native Children
Singleton et al.
Arch Pediatr Adolesc Med 2009;163:446-453.
ABSTRACT | FULL TEXT  

Invasive Pneumococcal Disease Among White Mountain Apache Adults, 1991-2005
Bliss et al.
Arch Intern Med 2008;168:749-755.
ABSTRACT | FULL TEXT  

Association of the Pneumococcal Pilus with Certain Capsular Serotypes but Not with Increased Virulence
Basset et al.
J. Clin. Microbiol. 2007;45:1684-1689.
ABSTRACT | FULL TEXT  

Vaccine Preventable Diseases and Vaccination Policy for Indigenous Populations
Menzies and McIntyre
Epidemiol Rev 2006;28:71-80.
ABSTRACT | FULL TEXT  

Epidemiology of Invasive Streptococcus pneumoniae among Navajo Children in the Era before Use of Conjugate Pneumococcal Vaccines, 1989-1996
O'Brien et al.
Am J Epidemiol 2004;160:270-278.
ABSTRACT | FULL TEXT  

Potential Impact of Conjugate Pneumococcal Vaccines on Pediatric Pneumococcal Diseases
O'Brien and Santosham
Am J Epidemiol 2004;159:634-644.
ABSTRACT | FULL TEXT  

Influenza and Pneumococcal Immunization in Diabetes
Diabetes Care 2004;27:s111-113.
FULL TEXT  

Immunization and the Prevention of Influenza and Pneumococcal Disease in People With Diabetes
Diabetes Care 2003;26:s126-128.
FULL TEXT  

The Future of Pneumococcal Conjugate Vaccines for Prevention of Pneumococcal Diseases in Infants and Children
Pelton and Klein
Pediatrics 2002;110:805-814.
ABSTRACT | FULL TEXT  

Technical Report: Prevention of Pneumococcal Infections, Including the Use of Pneumococcal Conjugate and Polysaccharide Vaccines and Antibiotic Prophylaxis
Overturf et al.
Pediatrics 2000;106:367-376.
ABSTRACT | FULL TEXT  

Invasive Pneumococcal Infection in Baltimore, Md: Implications for Immunization Policy
Harrison et al.
Arch Intern Med 2000;160:89-94.
ABSTRACT | FULL TEXT  

Immunizations for Native American Children
Committee on Native American Child Health and Comm
Pediatrics 1999;104:564-567.
FULL TEXT  

Molecular Analysis by Pulsed-Field Gel Electrophoresis and Antibiogram of Streptococcus pneumoniae Serotype 6B Isolates from Selected Areas within the United States
Rudolph et al.
J. Clin. Microbiol. 1998;36:2703-2707.
ABSTRACT | FULL TEXT  

Risk Factors for Primary Invasive Pneumococcal Disease Among Children in Finland
Takala et al.
JAMA 1995;273:859-864.
ABSTRACT  

The Pneumococcal Vaccine After 15 Years of Use
Hirschmann and Lipsky
Arch Intern Med 1994;154:373-380.
ABSTRACT