Streptococcus pneumoniae Disease, Invasive 2001

View ISDH's Streptococcus pneumoniae infection page

Rates presented are per 100,000 population and are based on the U.S. 2000 Census.

  Cases Incidence
Rate
Total 682 11.2
Race-specific cases and rates1
White 476 8.9
Black 94 18.4
Other2 3 1.2*
Sex-specific cases and rates
Female 337 10.9
Male 345 11.6

General Information

Surveillance of invasive Streptococcus pneumoniae (pneumococcal disease) has been ongoing in Indiana since June 1998. Among Indiana residents of all ages, 682 unduplicated cases were reported (11.15 cases per 100,000 population) in 2001, compared to 710 unduplicated cases reported (11.68 cases per 100,000 population) in 2000.

Incidence of invasive pneumococcal disease varies considerably with age, with the highest rates occurring in children under age 1 and in adults over age 65 (Figure Strep1).  There is also a strong seasonal trend in the number of reported cases, with the most cases reported in late winter and early spring, and the least in summer (Figure Strep2).

Race was identified on 573 of the reported cases. The white race was reported in 476 cases (representing 83.1% of cases where race was known) and African American or Black race was identified in 94 cases (16.4% of cases with known race). Of the 682 cases 337 (49.4%) were female and 345 (50.5%) were male.

Fifty-nine deaths were reported among the 682 cases. The outcome of 110 cases was not reported; therefore a death rate of 10.3% (59/572) was recorded for all ages where the outcome was known. The death rate for infants under age 1 with known outcome was 4.3% (1/23), a decrease from 10.4% (5/48) in 2000.

Drug-resistant Streptococcus pneumoniae (DRSP)

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

In Indiana during 2001, penicillin sensitivity data were received on 585 (85.8%) isolates. Of the cases where sensitivity information was available, 30.8% had either high level (16.9%) or intermediate level (13.9%) resistance to penicillin.

To better understand the resistance rates in Indiana, Table Strep1 lists the number of isolates and their sensitivity by county (only counties with 5 or more isolates are listed).

To compare data from 1999 to this table, see Appendix D of the 1999 Indiana Report of Diseases of Public Health Interest. For comparable data from 2000 see the 2000 Indiana Report of Infectious Diseases. If you do not have these reports, you can access them at the Indiana State Department of Health Website at: http://www.in.gov/isdh/dataandstats/disease/diseases_index.htm.

Sensitivity data can be compared from year to year to determine if the organism is becoming more resistant to various antibiotics. Table Strep2 shows selected antibiotics and the rates of resistance reported in 1999, 2000, and 2001.  As can be seen in Table Strep2, the percent of isolates that were resistant has remained fairly stable for the three-year period, with Cefotaxime, Erythromycin, and Clindamycin showing the biggest percentage increases.  It is hoped that, with increased pneumococcal conjugate vaccine use in 2002 and 2003, fewer cases will occur (particularly in those under age 2) and antimicrobial resistance will decrease.

Table Strep1. Invasive S. pneumoniae - Reported Cases and Antibiotic Sensitivity of Submitted Isolates by County, Indiana 2001

Invasive S. pneumoniae - Reported Cases and 
Antibiotic Sensitivity of Submitted Isolates by County

Indiana, 2001

County

Number of Reported Cases Incidence Rate per 100,000 Population Total Isolates Tested for Sensitivity Intermediate Level Resistance Isolates High Level Resistance Isolates Percent of Isolates High Level Resistant Sensitive Isolates
Allen 50 15.0 36 5 7 19.4% 24
Bartholomew 5 7.0* - - - - -
Dearborn 6 12.8* - - - - -
Delaware 19 16.0* 20 1 3 15.0% 16
Elkhart 25 13.6 14 0 1 7.1% 13
Fulton 5 24.2* - - - - -
Gibson 5 15.3* - - - - -
Grant 10 13.8* - - - - -
Hamilton 9 4.6* 12 2 2 16.7% 8
Hancock 10 17.5* - - - - -
Howard 5 5.9* 12 6 2 16.7% 4
Johnson 13 10.9* 8 2 4 50% 2
Knox 15 38.6* 10 2 1 10% 7
Kosciusko 7 9.4* - - - - -
Lake 65 13.4 52 9 5 9.6% 38
LaPorte 14 12.7* 8 1 0 0% 7
Lawrence 13 28.2* - - - - -
Madison 11 8.3* - - - - -
Marion 125 14.6 119 21 15 12.6% 83
Marshall 5 10.9* 7 0 1 14.3% 6
Monroe 20 16.7 10 0 7 70% 3
Morgan 5 7.4* 8 1 1 12.5% 6
St. Joseph 41 15.5 47 6 7 14.9% 34
Tippecanoe 26 17.4 - - - - -
Vanderburgh 48 28.0 48 6 10 20.8% 32
Vigo 33 31.5 15 2 1 6.7% 12
Wells 6 21.7* - - - - -
White 5 19.9* 9 2 1 11,1% 6

Source: Indiana State Department of Health
Note: Rates based on 2000 U.S. Census population.  All other counties had fewer than 
5 cases and are not reported to protect case confidentiality.  All rates based on less than 20 
cases and should be considered unstable.

 

Table Strep2. Invasive S. pneumoniae - Antimicrobial Resistance Rate of Selected Antibiotics, Indiana, 1999-2001

 

Invasive S. pneumoniae - Antimicrobial Resistance Rate for Selected Antibiotics
Indiana, 1999-2001

 

Antimicrobial Agent 1999 2000 2001
No. Tested % Res No. Tested % Res No. Tested % Res
Penicillin 595 27% 632 32% 585 31%
Cefotaxime 321 13% 303 15% 295 19%
Chloramphenicol 273 4% 228 7% 241 4%
Clindamycin 90 3% 82 6% 104 6%
Erythromycin 314 23% 321 30% 309 30%
Levofloxacin 51 1% 127 3% 229 <1%
Trimethoprim/Sulfamethoxazole 243 28% 287 35% 301 33%
Vancomycin 446 0% 504 0% 507 0%
Source: Indiana State Department of Health

Footnotes

1 - Race was unknown for 109 of the reported cases.

2 - "Other" includes American Indian/Alaska Native, Asian, Native Hawaiian/Pacific Islander, and multiracial.

* - Rate based on less than 20 cases and should be considered unstable.