1. Invasive Pneumococcal Disease Serotypes After the Introduction of Pneumococcal Seven-Valent Conjugate Vaccine Arizona,
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

2. 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

3. Background
Transition Slide

4. 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

5. 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

6. 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

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

8. 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, data
Infectious Disease Epidemiology

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

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

11. 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

12. 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

13. Serotype Distribution
Transition slide

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

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

16. 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

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

18. 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

19. 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

20. Serotype Distribution of PCV7 isolates Arizona, 2001 (n=36) vs
Serotype Distribution of PCV7 isolates Arizona, 2001 (n=36) vs (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

21. 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

22. Conclusions
Overall incidence of IPD disease in Arizona has decreased from , 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
IPD due to non-PCV7 serotypes has increased in all age groups in Arizona from
Infectious Disease Epidemiology

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

24. Thank you!