Pneumococcal Disease 2003

Table 1. Pneumococcal Disease Cases by Race and Sex, Indiana, 2003

  2003 1999-2003
Cases Rate* Cases
Total 618 10 2,748
Race
   White 405 7.40 1,834
   Black 95 17.90 447
   Other 0 0 6
   Not Reported 118 - 461
Sex
   Male 324 10.60 1,365
   Female 290 9.20 1,367
   Not Reported 4 - 16

*Rate per 100,000 population based on the U.S. Census Bureau’s population data as of July 1, 2003

Pneumococcal disease is caused by the bacterium Streptococcus pneumoniae and results in widespread illness and death in the United States. The major clinical syndromes of pneumococcal disease include pneumonia, bacteremia, and meningitis. Pneumococcal bacteria, of which there are over 90 serotypes, are common inhabitants of the respiratory tract.

Surveillance of invasive pneumococcal disease has been ongoing in Indiana since the summer of 1998. Figure 1 shows the number of cases for each year 1999-2003. Among Indiana residents of all ages, there were 618 reported cases (10.0 cases per 100,000 population) in 2003. Disease incidence was greatest during the winter and early spring months (Figure 2). Incidence of invasive pneumococcal disease varies considerably with age. In 2003, the age-specific rates were highest in adults aged 80 years and older (44.0), followed by infants less than 1 year of age (32.2) (Figure 3). In 2003, the incidence rate among the black population was more than double that of the white population as can be seen in Table 1. The difference in rates between genders was not significant.

In 2003, 73 counties reported at least 1 case of invasive pneumococcal disease, with 29 counties reporting 5 or more cases. The incidence rates were highest among the following counties reporting five or more cases: Lawrence (30.3), Vanderburgh (25.6), and Randolph (22.4). Cases are widely distributed geographically as can be seen in Figure 4. Only counties reporting five or more cases are represented.

Drug-Resistant Streptococcus pneumoniae (DRSP)

Antibiotic resistance has become an emerging world, national, and state problem in the treatment of pneumococcal disease. In the U.S., DRSP has increased substantially over the past 15 years; DRSP varies regionally and has been reported to be over 30 percent in some areas of the U.S.

Sensitivity data can be compared from year to year to determine if the organism is becoming more or less resistant to various antibiotics. Table 2 shows selected antibiotics and rates of resistance reported for 1999-2003. As can be seen in Table 2, the percent of isolates that are resistant has remained fairly stable for the five-year period.

Table 2:  Antimicrobial Resistance Rate of Selected Antibiotics (either high or intermediate level resistance), Indiana, 1999-2003

Antimicrobial Agent 1999 2000 2001 2002 2003
No. Tested % Res No. Tested % Res No. Tested % Res

No. Tested

% Res No. Tested % Res
Penicillin 595 27% 632 32% 585 31% 593 24% 522 25%
Cefotaxime 321 13% 303 15% 295 19% 275 8% 277 5%
Chloramphenicol 273 4% 228 7% 241 4% 231 1% 154 3%
Clindamycin 90 3% 82 6% 104 6% 113 0% 84 2%
Erythromycin 314 23% 321 30% 309 30% 343 26% 269 25%
Levofloxacin 51 1% 127 3% 229 <1% 266 3% 317 2%

Trimethoprim/
Sulfamethoxazole

243 28% 287 35% 301 33% 328 33% 260 28%
Vancomycin 446 0% 504 0% 507 0% 487 0% 474 0%

You can learn more about pneumococcal infections by visiting the following Web sites:
http://www.in.gov/isdh/25443.htm