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Invasive pneumococcal disease in non-Indigenous people in north Queensland, 2001–2009

Jeffrey N Hanna, Jan L Humphreys, Denise M Murphy and Helen V Smith
Med J Aust 2010; 193 (7): 392-396.

Summary

Objective: To compare trends in invasive pneumococcal disease (IPD) in non-Indigenous people in north Queensland before and after the introduction of funded pneumococcal vaccines, and to examine the proportion of cases that occurred after vaccine roll-out that could be vaccine-preventable.

Design, setting and participants: In 2005, a 7-valent pneumococcal conjugate vaccine (7vPCV) for non-Indigenous children and a 23-valent pneumococcal polysaccharide vaccine (23vPPV) for non-Indigenous adults aged ≥ 65 years were made freely available. Trends in IPD in the non-Indigenous estimated resident population in north Queensland (about 581 850 in 2006) were compared between the 4 years before (2001–2004) and after (2006–2009) the vaccines were rolled out.

Main outcome measures: Incidences and serotypes of IPD in non-Indigenous people.

Results: After the introduction of the vaccines, there were significant declines for all ages in the average annual incidence of IPD ( 34%; P < 0.05) and 7vPCV serotype IPD ( 77%; P < 0.05). In children aged < 5 years, there was a 91% decline in the incidence of 7vPCV serotype IPD (P < 0.05); in adults aged 15–64 years and ≥ 65 years there were 62% and 77% declines, respectively, in 7vPCV and 23vPPV common-serotype IPD (P < 0.05). There was a 188% increase in 23vPPV-only serotype IPD in adults aged 15–64 years (P < 0.05), whereas there was no significant change in adults aged ≥ 65 years. Serotype 19A was the most frequently identified serotype in 2006–2009, causing 19% of all IPD in those 4 years.

Conclusions: There is circumstantial evidence that 7vPCV has had a powerful indirect effect in preventing IPD in adults in north Queensland; 23vPPV may have had a direct effect in adults aged ≥ 65 years. It is likely that with combined direct and indirect effects, newer conjugate vaccines could prevent more IPD than could be prevented with the two current vaccines.

  • Jeffrey N Hanna1
  • Jan L Humphreys2
  • Denise M Murphy3
  • Helen V Smith3

  • 1 Cairns Population Health Unit, Tropical Regional Services, Division of the Chief Health Officer, Queensland Health, Cairns, QLD.
  • 2 Townsville Public Health Unit, Tropical Regional Services, Division of the Chief Health Officer, Queensland Health, Townsville, QLD.
  • 3 Reference Microbiology Laboratory, Public Health Microbiology, Queensland Health Forensic and Scientific Services, Brisbane, QLD.


Acknowledgements: 

We thank Rohan Pratt and Alexandra Raulli for assisting with the database and analyses, Vicki Hicks and Megan Penny for the serotyping, and Amy Jennison for the identification of serotype 6C IPD. We also thank the public health nursing officers in north Queensland who have collected the relevant case details over the years.

Competing interests:

Jeffrey Hanna has been a member of Wyeth and GlaxoSmithKline (GSK) pneumococcal advisory boards, and he has received travel grants from the Australian distributors of pneumococcal vaccines (Wyeth, CSL Biotherapies and GSK). Jan Humphreys received a travel grant from Novartis to attend a vaccine forum in 2007.

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