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Invasive pneumococcal disease in the Northern Territory of Australia, 1994–1998
Author(s) -
Krause Vicki L,
Reid Susan J C,
Merianos Angela
Publication year - 2000
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2000.tb139410.x
Subject(s) - indigenous , epidemiology , medicine , incidence (geometry) , case fatality rate , population , demography , pneumococcal conjugate vaccine , disease , geography , pediatrics , environmental health , streptococcus pneumoniae , biology , ecology , physics , genetics , sociology , bacteria , optics
Objective To examine the epidemiology of invasive pneumococcal disease (IPD) in the Northern Territory of Australia as a basis for optimising vaccination and healthcare provision. Design Prospective laboratory surveillance, with information collected from hospital and clinic records. Setting Northern Territory (NT) and rural communities in north‐west South Australia served by an NT hospital, 1994–1998 (NT population is 27% Indigenous). Main outcome measures IPD incidence and mortality, risk factors, clinical presentation and disease‐causing serotypes in Indigenous and non‐Indigenous people. Results 425 cases of IPD were detected, with 77% in Indigenous people. IPD incidence was highest in Indigenous children aged < 2 years (1534 per 1 in central Australia), but about 100 per 1 in non‐Indigenous children < 2 years and all Indigenous age groups aged ≥ 15 years. Mean ages of those with disease were 39 years in Indigenous people and 48 years in non‐Indigenous people ( P = 0.006) and, of those who died, 41 and 53 years, respectively ( P = 0.04). IPD risk factors were present in 72% of Indigenous and 55% of non‐Indigenous patients aged ≥ 2 years. Serotype results for 363 isolates showed that the 23‐valent vaccine covered 68% and 85% of isolates from Indigenous and non‐Indigenous people aged ≥ 2 years, respectively, while the proposed seven‐, nine‐ and 11‐valent conjugate vaccines covered 58%, 66% and 67% of isolates, respectively, from Indigenous children aged <2 years and 72% each of those from non‐Indigenous children. Case‐fatality rates were 10% in both Indigenous and non‐Indigenous people. Conclusion These data support the recent change in NT vaccination policy which extended funding for the 23‐valent vaccine to all Indigenous people aged ≥ 15 years and all Indigenous children in central Australia aged 2–5 years. The high rates of IPD in both Indigenous and non‐Indigenous children mandate action to make conjugate vaccine available as soon as possible.