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Invasive Pneumococcal Infection in Baltimore, Md
Implications for Immunization Policy
Lee H. Harrison, MD;
Diane M. Dwyer, MD;
Lillian Billmann, RN, MPH;
Margarette S. Kolczak, PhD;
Anne Schuchat, MD
Arch Intern Med. 2000;160:89-94.
Background Streptococcus pneumoniae is a leading cause of infectious morbidity and mortality. Although blacks are known to have a higher incidence of invasive pneumococcal infection than whites, detailed analyses of these differences and their implications for vaccine prevention have not been reported.
Objective To describe the epidemiological characteristics of invasive pneumococcal infection in Baltimore, Md, and its implications for immunization policy.
Methods Analysis of active, laboratory-based surveillance during 1995 and 1996 among residents of the Baltimore metropolitan area.
Results Of 1412 cases, 615 patients (43.6%) were classified as white and 766 (54.2%) as black. The annual incidence of invasive pneumococcal infection among white and black residents of the Baltimore metropolitan area was 17.8 and 59.2 per 100 000 population, respectively (P<.01). Among patients aged 18 years and older, the median age of blacks with invasive pneumococcal infections was 27 years younger than that of whites (P<.01). Among males 40 to 49 years old, blacks had a 12-fold higher average incidence than whites (average incidence, 114.5 and 9.3, respectively; P<.01). By the age of 65 years, 83.8% of cases had occurred in black adults, as compared with 43.8% in white adults (P<.01). In a regression model, age, black race, male sex, low median family income, and county prevalence of acquired immunodeficiency syndrome were each independently associated with a higher incidence of pneumococcal infection.
Conclusions Young urban black adults in the Baltimore metropolitan area have a dramatically higher incidence of invasive pneumococcal infection than whites. The vast majority of cases of invasive pneumococcal infection in blacks occur before age 65 years. Current immunization efforts have not addressed the high incidence of pneumococcal infection in this population.
From the Department of International Health, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md (Dr Harrison and Ms Billmann); Departments of Epidemiology and Medicine, University of Pittsburgh Graduate School of Public Health and School of Medicine, Pittsburgh, Pa (Dr Harrison); Epidemiology and Disease Control Program, Community and Public Health Administration, Maryland Department of Health and Mental Hygiene, Baltimore (Dr Dwyer); and Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Kolczak and Schuchat).
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