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Sustained Reductions in Invasive Pneumococcal Disease in the Era of Conjugate Vaccine
BackgroundChanges in invasive pneumococcal disease (IPD) incidence were evaluated after 7 years of 7-valent pneumococcal conjugate vaccine (PCV7) use in US children MethodsLaboratory-confirmed IPD cases were identified during 1998–2007 by 8 active population-based surveillance sites. We compared overall, age group-specific, syndrome-specific, and serotype group-specific IPD incidence in 2007 with that in 1998–1999 (before PCV7) and assessed potential serotype coverage of new conjugate vaccine formulations ResultsOverall and PCV7-type IPD incidence declined by 45% (from 24.4 to 13.5 cases per 100,000 population) and 94% (from 15.5 to 1.0 cases per 100,000 population), respectively (P<.01 for all age groups). The incidence of IPD caused by serotype 19A and other non-PCV7 types increased from 0.8 to 2.7 cases per 100,000 population and from 6.1 to 7.9 cases per 100,000 population, respectively (P<.01 for all age groups). The rates of meningitis and invasive pneumonia caused by non-PCV7 types increased for all age groups (P<.05), whereas the rates of primary bacteremia caused by these serotypes did not change. In 2006–2007, PCV7 types caused 2% of IPD cases, and the 6 additional serotypes included in an investigational 13-valent conjugate vaccine caused 63% of IPD cases among children <5 years-old ConclusionsDramatic reductions in IPD after PCV7 introduction in the United States remain evident 7 years later. IPD rates caused by serotype 19A and other non-PCV7 types have increased but remain low relative to decreases in PCV7-type IPD
Journal Article
Bacterial Meningitis in the United States, 1998–2007
The epidemiology of bacterial meningitis is evolving. In this report, over 3000 cases from selected areas of the United States are described; from 1998 to 2007, the incidence of bacterial meningitis decreased by 31%, but the disease still often results in death.
Studies in the 1970s and 1980s showed that five pathogens (
Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis,
group B streptococcus [GBS], and
Listeria monocytogenes
) caused more than 80% of cases of bacterial meningitis.
1
–
4
Between 1986 and 1995, the incidence of bacterial meningitis from these five pathogens declined by 55%, largely owing to the use of the
H. influenzae
type b (Hib) conjugate vaccine for infants, which was introduced in the United States in 1990.
5
Since then, additional interventions to prevent invasive disease from these pathogens have been introduced
6
–
8
(see also Table 1 in the Supplementary Appendix, available with . . .
Journal Article
Increasing Burden of Invasive Group B Streptococcal Disease in Nonpregnant Adults, 1990–2007
Background. Group B Streptococcus (GBS), traditionally considered to be a neonatal pathogen, is an important cause of morbidity and mortality among older adults and among those with underlying medical conditions. We used population-based surveillance to examine trends in adult GBS disease during the period 1990–2007 and to describe the epidemiology of adult GBS disease to guide prevention efforts. Methods. Active Bacterial Core surveillance was conducted in selected counties in 10 US states. A case was defined as isolation of GBS from a normally sterile site in a nonpregnant resident of a surveillance area who was ⩾18 years of age. Rates were calculated using US Census data. Demographic and clinical information was abstracted from medical records. Serotyping and susceptibility testing were performed on isolates collected from a subset of case patients. Results. A total of 19,512 GBS cases were identified in nonpregnant adults during 1990–2007 (median patient age, 63 years); the incidence of adult GBS disease doubled from 3.6 cases per 100,000 persons during 1990 to 7.3 cases per 100,000 persons during 2007 (P<.001). The mean difference in incidence between black and white persons was 4.6 cases per 100,000 persons (range, 3.1 cases per 100,000 persons during 1991 to 5.8 cases per 100,000 persons during 1999). Common clinical syndromes in 2007 included bacteremia without focus (39.3%), skin and/or soft-tissue infection (25.6%), and pneumonia (12.6%). Most (88.0%) GBS cases in adults had ⩾1 underlying condition; diabetes was present in 44.4% of cases. Serotypes V, Ia, II, and III accounted for 80.8% of infections during 1998–1999 and 78.5% of infections during 2005–2006. Conclusions. Invasive GBS disease in nonpregnant adults represents a substantial and increasing burden, particularly among older persons, black persons, and adults with diabetes. Prevention strategies are needed.
Journal Article
Incidence of Pneumococcal Disease Due to Non-Pneumococcal Conjugate Vaccine (PCV7) Serotypes in the United States during the Era of Widespread PCV7 Vaccination, 1998–2004
Background. Widespread use of pneumococcal conjugate vaccine (PCV7) resulted in decreases in invasive disease among children and elderly persons. The benefits may be offset by increases in disease due to serotypes not included in the vaccine (hereafter, \"nonvaccine serotypes\"). We evaluated the effect of PCV7 on incidence of disease due to nonvaccine serotypes. Methods. Cases of invasive disease were identified in 8 geographic areas through the Centers for Disease Control and Prevention's Active Bacterial Core surveillance. Serotyping and susceptibility testing of isolates were performed. We calculated the incidence of disease for children aged <5 years and adults aged ⩾65 years. We compared rates of serotype-specific disease before and after PCV7 was licensed for use. Results. The annual incidence of disease due to nonvaccine serotypes increased from an average of 16.3 cases/100,000 population during prevaccine years (1998–1999) to 19.9 cases/100,000 population in 2004 for children aged <5 years (P=.01) and from 27.0 cases/100,000 population during prevaccine years to 29.8 cases/100,000 population in 2004 for adults aged ⩾65 years (P=.05). Significant increases in the incidences of disease due to serotypes 3, 15, 19A, 22F, and 33F were observed among children during this period (P<.05 for each serotype); serotype 19A has become the predominant cause of invasive disease in children. The incidence of disease due to these serotypes also increased among elderly persons. Conclusions. The incidence of pneumococcal disease caused by nonvaccine serotypes is increasing. Ongoing surveillance is needed to monitor the magnitude of disease caused by nonvaccine serotypes, to ensure that future vaccines target the appropriate serotypes.
Journal Article
Effect of Pneumococcal Conjugate Vaccine on Pneumococcal Meningitis
Streptococcus pneumoniae
is an important cause of bacterial meningitis. Since the introduction of the heptavalent pneumococcal conjugate vaccine PCV7, rates of pneumococcal meningitis have decreased substantially in the United States, from 1.13 cases to 0.79 case per 100,000 persons between 1998–1999 and 2004–2005; rates of disease from serotypes covered by the vaccine decreased the most, and rates from those not covered increased.
Since the introduction of the heptavalent pneumococcal conjugate vaccine PCV7, rates of pneumococcal meningitis have decreased substantially in the United States, from 1.13 cases to 0.79 case per 100,000 persons between 1998–1999 and 2004–2005.
Streptococcus pneumoniae
is the most common cause of bacterial meningitis in the United States and many countries worldwide.
1
–
4
Despite effective antimicrobial therapy, pneumococcal meningitis remains highly lethal and has substantial long-term sequelae.
4
,
5
The pediatric heptavalent pneumococcal conjugate vaccine (PCV7; Prevnar, Wyeth) has had a major effect on the incidence of pneumococcal disease in the United States.
6
PCV7 not only protects immunized children from pneumococcal disease
7
–
11
but also provides protection to nonimmunized children and adults through herd immunity, resulting from reduced transmission of
S. pneumoniae
from immunized children.
8
,
10
,
12
,
13
Licensed in 2000, PCV7 is recommended by . . .
Journal Article
Evaluation of Universal Antenatal Screening for Group B Streptococcus
Invasive group B streptococcal disease is a leading cause of illness in the first week of life. Universal culture-based screening in the third trimester of pregnancy was recommended in the United States in 2002. This study shows that this policy has been associated with a decrease in the incidence of group B streptococcal disease. Populations that may benefit from additional preventive measures are identified.
Universal culture-based screening in the third trimester of pregnancy was recommended in the United States in 2002. This study shows that this policy has been associated with a decrease in the incidence of group B streptococcal disease.
Invasive group B streptococcal disease emerged in the 1970s as a leading infectious cause of illness and death in the first week of life.
1
Clinical trials in the 1980s showed that early-onset group B streptococcal disease (i.e., occurring in infants <7 days of age) may be prevented by administering antibiotic prophylaxis during labor and delivery to mothers who are colonized with group B streptococcus.
2
During the 1990s, candidates for intrapartum chemoprophylaxis were identified according to either a screening-based or a risk-based strategy
3
–
5
; this approach led to a 65% decrease in the incidence of early-onset group B streptococcal disease, . . .
Journal Article
Changes in Neisseria meningitidis Disease Epidemiology in the United States, 1998–2007: Implications for Prevention of Meningococcal Disease
Background In January 2005, a quadrivalent (serogroups A, C, Y, and W-135) meningococcal conjugate vaccine was licensed for use in adolescents. This report describes the epidemiologic features of meningococcal disease in the United States from January 1998 through December 2007, before and during implementation of adolescent quadrivalent meningococcal conjugate vaccination. Methods Data were collected from active surveillance for invasive Neisseria meningitidis conducted through the Active Bacterial Core surveillance (ABCs) sites during 1998–2007. Isolates from cases were serogrouped at the ABCs site and confirmed at the Centers for Disease Control and Prevention. Estimates of the incidence and number of cases in the 50 states were calculated, standardizing for race and age group. Results In the period 1998–2007, a total of 2262 cases of meningococcal disease were reported from ABCs sites; 11.3% of these cases were fatal. The estimated United States average annual incidence of meningococcal disease was 0.53 cases per 100,000 population (95% confidence interval, 0.51–0.55), and an estimated 1525 (95% confidence interval, 1470–1598) cases occurred annually. The annual incidence decreased 64.1%, from 0.92 cases per 100,000 population in 1998 to 0.33 cases per 100,000 population in 2007. Infants aged <1 year have the highest incidence of meningococcal disease (5.38 cases per 100,000 population). After introduction of the quadrivalent meningococcal conjugate vaccine, no significant decrease in serogroup C or Y meningococcal disease was seen among those aged 11–19 years in 2006–2007, compared with 2004–2005. Conclusions Before the introduction of the quadrivalent meningococcal conjugate vaccine, the incidence of meningococcal disease in the United States decreased to a historic low. However, meningococcal disease still causes a substantial burden of disease among all age groups. Future vaccination strategies may include targeting infants and preventing serogroup B meningococcal disease.
Journal Article
Asthma as a Risk Factor for Invasive Pneumococcal Disease
This case–control study in Tennessee assessed 635 persons 2 to 49 years of age with invasive pneumococcal disease and 6350 matched controls. Among those with asthma, the risk of invasive pneumococcal disease was about twice that among the controls; among those with high-risk asthma, the risk was more than three times as great. Asthma appears to be an independent risk factor for invasive pneumococcal disease. These data suggest that asthma should be an additional indication for pneumococcal vaccination.
This case–control study in Tennessee showed that among those with asthma, the risk of invasive pneumococcal disease was about twice that among the controls. Among those with high-risk asthma, the risk was more than three times as great.
Streptococcus pneumoniae
is the cause of substantial morbidity and mortality in the United States, particularly among people who are at high risk for pneumococcal infection.
1
Among those at risk, pneumococcal vaccination has been shown to prevent invasive disease from this ubiquitous pathogen.
1
,
2
The identification and confirmation of other groups at risk as potential candidates for vaccination are key steps in the prevention of invasive pneumococcal disease.
Unlike the known increase in the risk of invasive pneumococcal disease among persons with other chronic obstructive pulmonary diseases (COPDs) (e.g., emphysema and chronic bronchitis),
1
the risk among persons with asthma is unknown. . . .
Journal Article
Incidence of Invasive Pneumococcal Disease among Individuals with Sickle Cell Disease before and after the Introduction of the Pneumococcal Conjugate Vaccine
Background. We sought to determine the incidence of invasive pneumococcal disease (IPD) among individuals with sickle cell disease (SCD) before and after the introduction of the pneumococcal conjugate vaccine (PCV). Methods. Individuals with SCD who were enrolled in Tennessee Medicaid from January 1995 through December 2004 were identified using SCD-specific International Classification of Diseases, Ninth Revision, Clinical Modification codes. Population-based surveillance data were used to identify individuals with IPD and were linked to patients with SCD in the Tennessee Medicaid database to determine incidence rates of IPD. Clinical data were collected on all subjects with IPD, and antibiotic susceptibility testing and serotyping were performed on all available pneumococcal isolates. Results. We identified 2026 individuals with SCD, who constituted 13,687 person-years of follow-up. During the study period, 37 individuals with SCD developed IPD, and 21 of these patients were aged <5 years. In a comparison of the pre-PCV period (1995–1999) with the post-PCV period (2001–2004), the rate of IPD decreased by 90.8% in children aged <2 years (from 3630 to 335 cases per 100,000 person-years; P < .001) and by 93.4% in children aged <5 years (from 2044 to 134 cases per 100,000 person-years; P < .001). Rates of IPD for patients with SCD who were aged ≥5 years decreased from 161 cases per 100,000 person-years during the pre-PCV period to 99 cases per 100,000 person-years during the post-PCV period (P = .36). Conclusion. The rate of IPD among children with SCD who are aged <5 years has decreased markedly since the introduction of routine administration of PCV to young children.
Journal Article