Invasive Pneumococcal Disease in Dallas County, Texas: Results from Population‐Based Surveillance in 1995

Abstract

We studied the epidemiology of invasive disease caused by Streptococcus pneumoniae in 1995 among 1.9 million residents of Dallas County, Texas. The sociodemographic characteristics and chronic medical conditions of 432 patients were identified through active, population-based surveillance and review of medical records. The incidence of disease was 22 cases per 100,000 person-years and was highest for children < 2 years of age (136 cases per 100,000 person-years) and for adults > or = 65 years of age (80 cases per 100,000 person-years). Twenty percent of isolates were nonsusceptible to penicillin; the highest rates of resistance were among the youngest and oldest age groups (28% and 22% of isolates, respectively). An increased incidence of disease was associated with low income (42 cases per 100,000 person-years) and black race (39 cases per 100,000 person-years). The frequency of most chronic medical conditions increased with age; smoking, heavy alcohol use, and infection due to human immunodeficiency virus were most common between 30 and 64 years of age. Of otherwise healthy patients 30-64 years of age, 47% were current smokers, an association requiring further investigation. Characterizing groups at risk for invasive pneumococcal disease could aid in the development of prevention programs and increase the benefits from wide use of effective vaccines.

Relationship between Capsular Type, Penicillin Susceptibility, and Virulence of Human Streptococcus pneumoniae Isolates in Mice

“…Experimental pneumococcal pneumonia cannot be induced in immunocompetent mice by inoculation with wild resistant strains, independent of serotype (4). These data, and others suggesting that invasive strains are largely penicillin susceptible while less invasive strains are largely penicillin nonsusceptible (7,20,21,22,26), point to a correlation between penicillin susceptibility and virulence.…”

Prognostic score systems and community-acquired bacteraemic pneumococcal pneumonia

“…In contrast, case-fatality rates in studies of IPD from other centres, both inside and outside Sweden, have varied considerably, from ,3 to 25%, or higher [10,14,[20][21][22][23][24][25][26][27][28][29]. These varying case-fatality rates are likely to be due to differences between study populations concerning demographics, underlying health characteristics or severity of illness on admission to hospital [12,13].…”

Multilocus Sequence Typing Directly on DNA from Clinical Samples and a Cultured Isolate To Investigate Linked Fatal Pneumococcal Disease in Residents of a Shelter for Homeless Men

“…Chronic alcohol excess is a major risk factor for invasive pneumococcal disease, possibly the most important one among young and middle-aged adults (3,15,19). Altered risk associated with homelessness or living in shelters is less well established, although reports of outbreaks among these populations suggest that risk might be increased (6,17).…”

“…Altered risk associated with homelessness or living in shelters is less well established, although reports of outbreaks among these populations suggest that risk might be increased (6,17). A range of social and biological factors, particularly a high smoking prevalence, among alcoholics and the homeless may further increase their risk (17)(18)(19). Improved investigation of sporadic and linked cases among these groups should increase understanding of the pneumococcal disease burden that they bear.…”