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BACKGROUND: The objective of this study was to show trends in invasive pneumococcal disease (IPD) and antibiotic resistant strains in Utah after the licensure and implementation of 13-valent-valent pneumococcal vaccine (PCV13).
METHODS: Since mid-2005, Utah has mandated reporting of all cases of IPD, irrespective of age or antibiotic resistance. In Utah, PCV13 was approved and implemented in February 2010. Temporal trends of IPD and highly-resistant pneumococcal (HRP) strains reported to the health department during 2006-2012 were analyzed[AN1] . HRP strains were defined as those resistant to 7 or more classes of antibiotics.
RESULTS: A total of 1,597 cases and 111 deaths due to IPD were reported during this period. On average, there were 243 cases and 17 deaths reported per year for the period before (2006-2009), and 208 cases and 10 deaths for the period after (2010-2012) PCV13 implementation. Before PCV13, on average 52 (21%) of the reported cases and 1 death (5.8%) per year were among children <5 years of age; after vaccine implementation, 27(12.8%) cases and 1 death (10%) were among this same age group. Overall mean IPD rates decreased significantly in Utah (from 9.25 to 7.34 per 100,000 population, respectively, t=-2.63, p=0.046). The decrease in mean IPD rate was most significant in children <5 years of age (from 20.29 to 10.27 per 100,000 population, t=-4.10, p=0.009) A non-significant reduction was also seen in patients > 65 years (from 27.85 to 23.55 per 100,000 population, t=-1.25, p=0.25), but no effect was observed for those aged 5-64 years. There were significant no differences in the overall mean case fatality rates comparing the years before (2006-2009) to the years after (2010-2012) vaccine introduction (6.92 vs. 8.20 per 100,000 population, respectively, t=0.60, p=0.57); or for the three age groups (ages <5, 2.16 vs. 3.30 per 100,000 population, t=0.61, p=0.56; ages 5-64, 6.79 vs. 6.72 per 100,000 population, t=0.02, p=0.98; ages >65, 12.29 vs. 12.26 per 100,000 population, t=0.01, p=0.99). The percentage of isolates that were HRP increased yearly from 0 in 2006 to 3.9% in 2010 and decreased thereafter.
CONCLUSIONS: The of main goal of the licensure of the PCV13 was to both reduce morbidity and mortality due to IPD in pediatric populations, with presumed impact on other age groups; overall, both these goals have been met. A secondary goal was to reduce the incidence of HRP strains; this goal may also have been met, but further analysis is needed.