Abstract
BackgroundIncidence, manifestations and case-fatality rate (CFR) of invasive pneumococcal disease (IPD) vary with age and comorbidities. New vaccines, changing age distribution, prolonged survival among immunocompromised patients and improved sepsis management have created a need for an update of basic facts to inform vaccine recommendations.MethodsAge, gender and comorbidities were related to manifestations and death for 2977 consecutive patients with IPD in a Swedish region with 1.5 million inhabitants during 13 years before introduction of pneumococcal conjugate vaccines (PCV) in the infant vaccination program. These data were related to population statistics and prevalence of several comorbidities, and compared with two previous studies giving a total follow-up of 45 years in the same area.ResultsThe annual incidence was 15/100,000 for any IPD and 1.1/100,000 for meningitis; highest among elderly followed by children < 2 years. It was 2238/100,000 among myeloma patients, followed by chronic lymphatic leukemia, hemodialysis and lung cancer, but not elevated among asthma patients. CFR was 10 % among all patients, varying from 3 % below 18 years to 22 % ≥ 80 years. During 45 years, the IPD incidence increased threefold and CFR dropped from 20 to 10 %. Meningitis incidence remained stable (1.1/100,000/year) but CFR dropped from 33 to 13 %. IPD-specific mortality decreased among children <2 years from 3.1 to 0.46/100,000/year but tripled among those ≥65 years.ConclusionsIPD incidence and CFR vary widely between age and risk groups and over time even without general infant vaccination. Knowledge about specific epidemiological characteristics is important for informing and evaluating vaccination policies.
Highlights
Incidence, manifestations and case-fatality rate (CFR) of invasive pneumococcal disease (IPD) vary with age and comorbidities
Streptococcus pneumoniae causes a broad spectrum of diseases from otitis media and sinusitis, to nonbacteremic pneumonia and, to invasive pneumococcal diseases
The annual incidence among children aged 0–1 years, 23/100,000, was low compared to many other countries prior to pneumococcal conjugate vaccines (PCV) vaccination, large variations are seen between populations at a comparable socioeconomic level [13, 27]
Summary
Manifestations and case-fatality rate (CFR) of invasive pneumococcal disease (IPD) vary with age and comorbidities. Differences in incidence and case fatality rate (CFR) between countries at comparable socioeconomic levels [7], and between different time periods in the same country [8], might reflect an unequal distribution, both over time and geographically, of clones and serotypes with different virulence. Such differences should be interpreted with caution [9], because of selection bias due to the impact of different blood culturing practices. When fewer blood cultures are performed the incidence seems lower, and if only severe cases are blood cultured, CFRs appear higher
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