Invasive Pneumococcal Disease Serotypes After the Introduction of Pneumococcal Seven-Valent Conjugate Vaccine Arizona, 2001-2005 Susan Goodykoontz, Daniel Bronson-Lowe, Clare Kioski, Shoana Anderson, Blaine Mathison, Kathy Fredrickson and Rebecca Sunenshine Arizona Department of Health Services National Immunization Conference, Kansas City, MO March 7th, 2007

Presentation Outline Review background of invasive pneumococcal disease (IPD) surveillance in Arizona Reporting Disease Rates Immunization Coverage Examine changing epidemiology of IPD in Arizona from 2001 to 2005 Serotype Distribution (PCV7 vs. Non-PCV7 serotypes) Age Distribution Compare post-vaccination serotype distribution in Arizona to the United States for 2002 Infectious Disease Epidemiology

Background Transition Slide

Reporting of IPD in Arizona Since 1997, Streptococcus pneumoniae isolated from a normally sterile site has been reportable by Arizona laboratories In 2004, IPD became reportable by providers Also in 2004, laboratories were required to forward pneumococcal isolates from sterile sites to the Arizona State Laboratory for serotyping and isolate archiving Infectious Disease Epidemiology

Surveillance Methods Case is required to be reported by provider to local health department within 5 days of diagnosis Streptococcus pneumoniae isolated from a normally sterile site is reported by laboratories to ADHS; isolates are required to be forwarded to Arizona State Laboratory (since 2004) Isolates received by Arizona State Laboratory are serotyped and archived Case and laboratory data are entered into the state’s electronic case surveillance system. Additionally, laboratory data are entered into the state’s laboratory electronic data system Infectious Disease Epidemiology

Pneumococcal Seven-Valent Conjugate Vaccine (PCV7) Introduced in the United States in 2000 Added to United States childhood immunization schedule in 2001 National PCV7 vaccine shortage from August 2001 through May 2003 Infectious Disease Epidemiology

Invasive Pneumococcal Disease Rates Arizona and United States, 1997 - 2005 PCV7 Introduction PCV7 Shortage Source for US data: ABC Surveillance Reports, CDC, 1997-2005 Infectious Disease Epidemiology

Estimated Vaccine Coverage for Three Doses of PCV7 Vaccine Arizona and United States, 2003 - 2006 Go back to rates slide – although vaccine coverage roughly the same, disease reduction in AZ has not been significant Source: CDC National Immunization Survey, 2003-2006 data Infectious Disease Epidemiology

Rates of IPD by Age Group Arizona, 2001, 2003, and 2005 Infectious Disease Epidemiology

IPD by Race and Ethnicity Arizona, 2001 and 2005 Black 3% 2001 (n=784) 2005 (n = 726) Infectious Disease Epidemiology

IPD Rates by County Arizona, 2001 Apache 18.9 Coconino 25.4 Mohave 22.9 >=20 10 < rate < 20 <=10 Navajo 19 Yavapai 3.4 La Paz Gila 13.6 Maricopa 14.8 Greenlee Pinal 15.9 Graham Yuma 0.6 Pima 16.6 Cochise 10.9 Santa Cruz 26.4 Rates/100,000 persons Infectious Disease Epidemiology

IPD Rate Ratios by County Arizona, 2001 vs. 2005 Coconino 0.79 Apache 0.29* Mohave 0.42* RR <=.5 .5 < RR < 1 RR >=1 Navajo 0.72 Yavapai 1.15 La Paz 19.9** Gila 0.81 Maricopa 0.87 Greenlee25.5** Pinal0.82 Graham 9.5** Yuma 0.63 Pima 0.74 Cochise0.97 *p=0.05, **p=0.001 Santa Cruz 0.09** Infectious Disease Epidemiology

Serotype Distribution Transition slide

Number of IPD Isolates Serotyped at the Arizona State Laboratory and Total Reported IPD Cases, 2000-2005 Isolates required to be forwarded to State Laboratory Infectious Disease Epidemiology

Rates of Invasive Pneumococcal Disease PCV7 vs Rates of Invasive Pneumococcal Disease PCV7 vs. Non-PCV7 Serotypes, Arizona, 2001 – 2005 Infectious Disease Epidemiology

Rates of Invasive Pneumococcal Disease PCV7 vs Rates of Invasive Pneumococcal Disease PCV7 vs. Non-PCV7 Serotypes Children < 5 Years, Arizona, 2001 – 2005 Infectious Disease Epidemiology

PCV7 vs. Non-PCV7 Serotypes Arizona, 2001, 2003 and 2005 Infectious Disease Epidemiology

Comparison of Rates by PCV7 Serotype Status United States and Arizona, 2002 Source for US Data: Beall, B et al. J. Clin. Microbiol, 2006, 44,( 3). Infectious Disease Epidemiology

Comparison of Rates by PCV7 Serotype Status in Children < 5 Years United States and Arizona, 2002 Source for US Data: Beall, B et al. J. Clin. Microbiol, 2006, 44,( 3). Infectious Disease Epidemiology

Serotype Distribution of PCV7 isolates Arizona, 2001 (n=36) vs Serotype Distribution of PCV7 isolates Arizona, 2001 (n=36) vs. 2005 (n=17) Although the number of isolates serotyped as PCV7 has decreased dramatically, the same three major serotypes seen in 2002 comprise the 2005 distribution. 2005 (n = 17) 2001 (n=36) Infectious Disease Epidemiology

Limitations Incomplete data (i.e. race, demographics) Only reportable by laboratories until 2004 (limited amount of data prior to this time) Forwarding of isolates was not mandatory until 2004 Infectious Disease Epidemiology

Conclusions Overall incidence of IPD disease in Arizona has decreased from 2001 - 2005, although this decrease is not statistically significant (p value = 0.564) PCV7 immunization is likely reducing the incidence of IPD disease due to PCV7 serotypes in all age groups in Arizona Non-PCV7 serotypes have comprised the majority of Arizona IPD disease in all age groups from 2001-2005 IPD due to non-PCV7 serotypes has increased in all age groups in Arizona from 2001-2005 Infectious Disease Epidemiology

Acknowledgements Arizona Infection Control Practitioners Mary Finnerty and staff at the Arizona State Laboratory Infectious Disease Epidemiology

Thank you!