Changing Epidemiology of Invasive Pneumococcal Disease Among Older Adults in the Post 13-Valent Pneumococcal Conjugate Vaccine Era in Atlanta’s Metropolitan Statistical Area. Open Access

Tracy, Marissa (Summer 2019)

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Background- In 2010, a 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the U.S. in children 2> years old resulting in dramatic reductions in invasive pneumococcal disease (IPD) in children 5> years old and adults ≥65 years old. In 2014, the Advisory Committee on Immunization Practices (ACIP) recommended PCV13 use in adults ≥65 years old. IPD trends from 2008-2017 were evaluated to investigate the impact of changing vaccination practices on the epidemiology of IPD in adults ≥65 years old in Atlanta’s Metropolitan Statistical Area (MSA).

Methods- Laboratory- and population-based surveillance data collected by CDC’s Emerging Infections Program (EIP) / Active Bacterial Core Surveillance (ABCs) were used to calculate race-, sex-, age-, and serotype-specific IPD incidence from 2008-2017 among older adults in the Atlanta MSA. IPD-related mortality was modeled using logistic regression to evaluate risk-factors for death among older adults in the late-PCV13 era (2015-2017).

Findings- Overall IPD incidence declined significantly in older adults from 2008-2017. Race- and serotype-specific IPD rates also declined significantly. Disease burden shifted from white females in the pre-PCV13 era (2008-2010) to black males in the post-PCV13 era (2011-2017). By 2013, the rate decline in whites surpassed the rate decline in blacks. PCV13 serotypes declined significantly during the time frame. The rate ratio of PCV13 serotype disease compared to non-vaccine serotypes of disease dropped from 1.5 in the pre-PCV13 era to 0.48 in the late-PCV13 era. Modeling for IPD-related death revealed that receipt of any pneumococcal vaccine and black race had a protective effect against mortality whereas ICU admission and septic shock were associated with increased risk of death.

Interpretation- Vaccination plays a critical role in reducing IPD and IPD-related mortality in adults ≥65 years old. Efforts to increase PCV13 adherence in children 2> years old and PCV13 uptake in older adults is essential to further reduce IPD rates, particularly in black persons. More research must but done to understand the impact of PCV13 use in older adults ≥65 years old.

Table of Contents


Introduction: epidemiology and impact of the pneumococcus. 1

Risk factors for IPD.. 2

Age and underlying conditions. 2

Racial and socioeconomic disparities. 3

Bacterial characteristics of the pneumococcus. 4

Vaccination strategies for pneumococcal disease prevention. 6

Thesis rationale and objectives. 8


Study Population. 9

Core Variables. 10

Statistical Analyses. 11



Trends in IPD incidence in the elderly: racial disparities. 16

Trends in IPD incidence in the elderly: serotype group. 17

Risk factors for IPD-related mortality. 18

Strengths & Limitations. 20

Public Health Importance & Future Directions. 21



Tables. 27

Figures. 43

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