Impact of PCV on Antibiotic Resistance • CID 2004:39 (1 September) • 641
M A J O R A R T I C L E
Reduction in High Rates of Antibiotic-Nonsusceptible
Invasive Pneumococcal Disease in Tennessee after
Introduction of the Pneumococcal Conjugate Vaccine
Thomas R. Talbot,1,2Katherine A. Poehling,3Tina V. Hartert,1Patrick G. Arbogast,4,5Natasha B. Halasa,3Ed Mitchel,2
William Schaffner,1,2Allen S. Craig,2,7Kathryn M. Edwards,3and Marie R. Griffin1,2,5,6
Vanderbilt University School of Medicine, and
Healthcare System, and
6The Geriatric Research Education and Clinical Center, Veterans Affairs, Tennessee Valley
7The Tennessee Department of Health, Nashville, Tennessee
5Center for Education and Research on Therapeutics,
(See the editorial commentary by Klugman on pages 649–51)
Invasive pneumococcal disease (IPD) is a burgeoning problem, with rates of antibiotic-
nonsusceptible IPD, in particular, increasing during the past decade. One measure to combat IPD is vaccination
with the recently introduced 7-valent pneumococcal conjugate vaccine (PCV).
To evaluate the effects of the introduction of PCV in 2000 on the epidemiology of antibiotic-
nonsusceptible IPD, a database of IPD cases from January 1995 through December 2002 identified through active
surveillance in 5 Tennessee counties was examined. For each case, clinical data were collected, and antibiotic
susceptibility testing and serotyping were performed on available isolates.
Among children younger than 2 years, IPD rates peaked at 235 cases per 100,000 in 1999 before
decreasing, after PCV licensure, to 46 cases per 100,000 in 2002 (
ceptible IPD isolates from this age group declined from 59.8% in 1999 to 30.4% in 2002 (
similar decreases in IPD rates and in the proportion of antibiotic-nonsusceptible isolates recovered were seen
among persons aged 2 years and older (). Rates of IPD due to PCV-associated serotypes declined after PCVP ! .01
introduction in all age groups (), whereas the rate of IPD due to nonvaccine serotypes increased amongP ! .001
persons aged 2 years and older.
In the 2 years since licensure, widespread PCV vaccination of children has resulted in dramatic
declines in the proportion of antibiotic-nonsusceptible isolates in Tennessee. PCV vaccination of children also
appears to be a highly effective method for reducing the burden of IPD in adults.
). The proportion of penicillin-nonsus-
P ! .01
P ! .001
). After 2001,
Invasive diseases due to Streptococcus pneumoniae,such
as pneumonia, sepsis, and meningitis, cause substantial
morbidity and mortality. Antibiotic-nonsusceptible
pneumococcal disease has become an increasing prob-
lem throughout the world, and Tennessee, inparticular,
has some of the highest rates of antibiotic-nonsuscep-
tible pneumococcal isolates reported in the United
States . Published reports illustrated that 170% of
S. pneumoniae isolates from 2 geographically distinct
Received 26 February 2004; accepted 27 March 2004; electronically published
16 August 2004.
Presented in part: 41st Annual Meeting of the Infectious Diseases Society of
America, San Diego, California, 11 October 2003 (abstract 483).
Reprints or correspondence: Dr. Thomas R. Talbot, A-4103C Medical Center
North, 1161 21st Ave. S., Nashville, TN 37232 (firstname.lastname@example.org).
Clinical Infectious Diseases2004;39:641–8
? 2004 by the Infectious Diseases Society of America. All rights reserved.
urban Tennessee communities were nonsusceptible to
pneumococcal disease and the mounting problem of
antibiotic-nonsusceptible disease in Tennessee is, there-
A cornerstone in the efforts to reduce the burden of
invasive pneumococcal disease (IPD) has been pneu-
mococcal vaccination. Licensed in 1977, the 23-valent
polysaccharide vaccine (PPV), which contains purified
capsular antigens for 23 pneumococcal serotypes, re-
duces the risk of pneumococcal bacteremia in vacci-
nated individuals aged 2 years and older but is inef-
fective in younger children and does not decrease the
rate of noninvasive pneumococcal infections [4, 5].The
limited success of PPVprompteddevelopmentofnewer
pneumococcal vaccines. In 2000, a pneumococcal con-
jugate vaccine (PCV) containing the 7 serotypes most
commonly associated with invasive and antibiotic-
by guest on February 2, 2016
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