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Annual report Invasive pneumococcal disease in Australia, 2004 via increased herd immunity. Although increases in disease caused by non-7vPCV serotypes have been seen, these have been small relative to the declines in 7vPCV serotype disease. It has been recently estimated that the universal 7vPCV will prevent more than 80 per cent of childhood IPD and associated mortality in Australia. 7vPCV may also prevent 6 per cent of all pneumonia, 18 per cent of radiographically-defi ned pneumonia, 6 per cent of otitis media and 20–40 per cent of tympanostomy procedures in children under 5 years. 9 A reduction of 80 per cent may be a slight over-estimation, since IPD due to 7vPCV serotypes has accounted for only 72–74 per cent of disease in children aged under 2 years in recent years; nevertheless a signifi cant reduction is anticipated. An analysis of the impact of the fi rst year of the universal 7vPCV vaccination program on IPD in Australia will be provided in the next report. Recent studies have revealed high-risk groups for IPD who could benefi t from vaccination. A case control study in the USA identifi ed asthma in persons aged 2–49 years as an independent risk factor for IPD. 10 Another USA study estimated the increased risk of IPD for specifi c chronic diseases, controlling for age and race. 11 Relative risks (compared to healthy adults) were 5.8 for diabetes, 6.9 for chronic lung disease, 10.4 for chronic heart disease, 11.5 for alcohol abuse, 32.2 for solid cancer, 48.8 for HIV/ AIDS and 52.2 for haematological cancers. These observations support the recommendations in the Australian Immunisation Handbook that such highrisk groups receive the 23vPPV. 12 The changing epidemiology of IPD in the era of pneumococcal conjugate vaccines is the subject of continuing research. Changes in serotypes causing IPD (‘serotype replacement’) are being measured through on-going laboratory surveillance. Despite increased prevalence of non-7vPCV serotypes in Indigenous children between 2001 and 2005, the overall rate of IPD continues to decline. Some concern has been raised about non-7vPCV serotypes causing unusual or severe presentations of IPD such as para-pneumonic empyema. 13 However, a recent review of apparent epidemiological differences between serotypes concluded that 7vPCV serotypes are the most prevalent in children aged 6 months to 2 years and in the immunocompromised and elderly adults. Continued epidemiological surveillance is required to determine whether increases in the prevalence of some non-vaccine serotypes are more signifi cant than others. 14 The use of 7vPCV in Indigenous children in Australia over the past three years has successfully reduced the rate of IPD to that of non-Indigenous children. There is, to date, no evidence of signifi cant non- 7vPCV serotype ‘replacement’ disease. Rates of pneumococcal resistance to penicillin are modest and resistance to ceftriaxone/cefotaxime remains rare. The introduction of the 7vPCV to the universal vaccination schedule in Australia in 2005 will further lower the disease burden of IPD among children and may contribute to reduction in other age groups. Continued enhanced IPD surveillance will be critical to assessing the impact of the expanding pneumococcal vaccine strategies. Acknowledgements The following laboratories are gratefully acknowledged for their support of Pneumococcal Laboratory Surveillance. ACT The Canberra Hospital New South Wales The Children’s Hospital, Westmead Central Coast Pathology Concord Hospital Douglass Hanley Moir Hunter Area Pathology Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research Laverty Pathology THE Pathology Nepean Hospital Pacifi c Laboratory Medicine Services Royal Prince Alfred Hospital South Eastern Area Laboratory Services St George Hospital St Vincent’s Hospital South West Area Pathology Services Sydney Adventist Hospital Wollongong Hospital Northern Territory Royal Darwin Hospital, Department of Microbiology Private laboratories in the Northern Territory Alice Springs Hospital Department of Microbiology Katherine Hospital Department of Microbiology Gove District Hospital Tennant Creek Hospital 90 CDI Vol 30 No 1 2006
Invasive pneumococcal disease in Australia, 2004 Annual report Queensland Queensland Health Pathology Laboratories and the Microbiology Discipline Working Party Private Pathology Laboratories throughout Queensland Tropical Public Health Unit, Cairns Communicable Diseases Unit, Brisbane South Australia Women’s and Children’s Hospital, Adelaide The Gribbles Group South Path Microbiology and Infectious Diseases Clinipath Laboratories Institute for Medical and Veterinary Science laboratories Tasmania Robert Peterson, Royal Hobart Hospital (Department of Microbiology) Launceston General Hospital (Northern Tasmanian Pathology Service) Hobart Pathology North West Pathology Victoria The Microbiology Diagnostic Unit, Public Health Laboratory, is grateful to the following laboratories who have been identifi ed as having contributed isolates to the reported data-set: Box Hill Hospital Pathology Service Royal Childrens Hospital (Parkville) Pathology Service Dorevitch Pathology Mayne Health (Heidelberg) Gippsland Pathology Service Sale (& Traralgon) Alfred Hospital Pathology Service Monash Medical Centre (Clayton) Pathology Service Austin Hospital Pathology Service Bendigo Health Pathology Service Goulburn Valley Health (Shepparton) Pathology Service Northern Hospital (Epping) Pathology Service St John of God Health Care Ballarat Pathology Service Geelong Hospital Pathology Service (Pathcare) South West Healthcare (Warnambool) Pathology Service Saint Frances Xavier Cabrini Hospital Pathology Service Royal Melbourne Hospital (Parkville) Pathology Service St Vincents Hospital (Melbourne) Ltd Pathology Service Ballarat Health Services (Base campus) Pathology Service Forensicare – Victorian Institute of Forensic Medicine Wimmera Base Hospital (Horsham) Pathology Service Gribbles Pathology (Melbourne) Echuca Hospital Pathology Service Mildura Base Hospital Pathology Service Melbourne Pathology St John of God Health Care Mildura Pathology Service From the Microbiology Diagnostic Unit, Public Health Laboratory, Ms Janet Strachan contributed to testing, Dr Mark Veitch and Ms Sally Bodenham to data management. Western Australia We would like to acknowledge the Vaccine Impact Surveillance Network which is funded by the Meningitis Centre of Western Australia and The Telethon Institute for Child Health Research. Princess Margaret and King Edward Memorial Hospitals Department of Microbiology Fremantle Hospital Department of Microbiology WA PathWest Royal Perth Hospital Department of Microbiology St John of God Pathology Department of Microbiology Western Diagnostic Pathology Department of Microbiology Clinipath Department of Microbiology CDI Vol 30 No 1 2006 91
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