Pneumococcal Disease 2002

Table 1. Pneumococcal Disease Cases by Race and Sex, Indiana, 2002

  2002 1998-2002
Cases Rate* Cases
Total 667 10.83 2,748
Race
   White 446 8.5 1,834
   Black 95 18.09 447
   Other 1 - 6
   Not Reported 105 - 461
Sex
   Male 330 10.53 1,365
   Female 335 11.07 1,367
   Not Reported 2 - 16

*Rate per 100,000 population based on the U.S. Census Bureau’s population data as of July 1, 2002

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 1998-2002. Among Indiana residents of all ages, there were 667 reported cases (10.83 cases per 100,000 population) in 2002.

Disease incidence was greatest during the early winter to late spring months (Figure 2). Incidence of invasive pneumococcal disease varies considerably with age, with the highest rates occurring in infants less than 1 year of age and in adults 60+ years of age (Figure 3).

In 2002, 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 2002, 72 counties reported at least 1 case of invasive pneumococcal disease, with 27 counties reporting 5 or more cases. The incidence rates were highest among the following counties reporting five or more cases: Knox (38.9), Vigo (29.5), Vanderburgh (27.4), Fulton (24.1), and Lawrence (21.7). Cases are widely distributed geographically as can be seen in Figure 4. Only counties reporting five or more cases are represented.

In 2002, 72 deaths resulted from the 667 reported cases. The outcome of 137 cases was not reported; therefore, a death rate of 13.6 percent (72/530) was recorded for all ages where the outcome was known.

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 1999-2002. As can be seen in Table 2, the percent of isolates that are resistant has remained fairly stable for the four-year period. Worth noting is the drop in the penicillin-resistance rate from 32 percent in 2000 to 24 percent in 2002. In addition, the rates for most antibiotics dropped slightly from 2001 to 2002

Table 2:  Antimicrobial Resistance Rate of Selected Antibiotics (either high or intermediate level resistance), Indiana, 1999-2002

Antimicrobial Agent 1999 2000 2001 2002
No. Tested % Res No. Tested % Res No. Tested % Res No. Tested % Res
Penicillin 595 27% 632 32% 585 31% 594 24%
Cefotaxime 321 13% 303 15% 295 19% 275 8%
Chloramphenicol 273 4% 228 7% 241 4% 231 1%
Clindamycin 90 3% 82 6% 104 6% 113 0%
Erythromycin 314 23% 321 30% 309 30% 343 26%
Levofloxacin 51 1% 127 3% 229 <1% 266 3%

Trimethoprim/
Sulfamethoxazole

243 28% 287 35% 301 33% 328 33%
Vancomycin 446 0% 504 0% 507 0% 488 0%

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