Brendan Flannery, PhD; Richard T. Heffernan, MPH; Lee H. Harrison, MD; Susan M. Ray, MD; Arthur L. Reingold, MD; James Hadler, MD, MPH; William Schaffner, MD; Ruth Lynfield, MD; Ann R. Thomas, MD, MPH; Jianmin Li, DPE; Michael Campsmith, DDS, MPH; Cynthia G. Whitney, MD, MPH; Anne Schuchat, MD
Note: This paper was presented in part at the 4th International Symposium on Pneumococci and Pneumococcal Diseases, Helsinki, Finland, 9 to 13 May 2004 (abstract EPI-05), and at the 42nd Annual Meeting of the Infectious Diseases Society of America, Boston, Massachusetts, 30 September to 3 October 2004 (abstract 746).
Acknowledgments: The authors thank the study personnel from the following institutions: Centers for Disease Control and Prevention; the Active Bacterial Core surveillance sites; Minnesota Department of Health; and the University of Texas Health Science Center. They also thank the AIDS surveillance officers.
Grant Support: By the Emerging Infections Program of the Centers for Disease Control and Prevention.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Brendan Flannery, PhD, Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C-23, Atlanta, GA 30333; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Flannery, Campsmith, Li, Whitney, and Schuchat: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333.
Mr. Heffernan: Connecticut Emerging Infections Program, 410 Capital Avenue, Hartford, CT 06134.
Dr. Harrison: Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205.
Dr. Ray: Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA 30303.
Dr. Reingold: University of California, Berkeley, 140 Warren, Berkeley, CA 94720-7360.
Dr. Hadler: Connecticut Department of Public Health, 410 Capital Avenue, MS 11 FDS, Hartford, CT 06134-0308.
Dr. Schaffner: Vanderbilt University Medical School, A-1124 MCN, Nashville, TN 37232.
Dr. Lynfield: Minnesota Department of Health, 717 Delaware Street SE, Minneapolis, MN 55414.
Dr. Thomas: Oregon Department of Human Services, 800 NE Oregon Street, Portland, OR 97212.
Author Contributions: Conception and design: B. Flannery, L.H. Harrison, A.L. Reingold, J. Hadler, A.R. Thomas, A. Schuchat.
Analysis and interpretation of the data: B. Flannery, R.T. Heffernan, A.L. Reingold, A.R. Thomas, J. Li, C.G. Whitney, A. Schuchat.
Drafting of the article: B. Flannery, A.L. Reingold, M. Campsmith.
Critical revision of the article for important intellectual content: L.H. Harrison, S.M. Ray, A.L. Reingold, J. Hadler, W. Schaffner, R. Lynfield, A.R. Thomas, J. Li, M. Campsmith, C.G. Whitney, A. Schuchat.
Final approval of the article: B. Flannery, L.H. Harrison, S.M. Ray, A.L. Reingold, J. Hadler, W. Schaffner, R. Lynfield, A.R. Thomas, J. Li, M. Campsmith, C.G. Whitney, A. Schuchat.
Provision of study materials or patients: J. Hadler, W. Schaffner, R. Lynfield.
Statistical expertise: J. Li.
Obtaining of funding: C.G. Whitney, A. Schuchat.
Administrative, technical, or logistic support: A.L. Reingold, W. Schaffner, R. Lynfield, C.G. Whitney.
Collection and assembly of data: R.T. Heffernan, S.M. Ray, J. Hadler, W. Schaffner, A.R. Thomas.
Flannery B, Heffernan RT, Harrison LH, Ray SM, Reingold AL, Hadler J, et al. Changes in Invasive Pneumococcal Disease among HIV-Infected Adults Living in the Era of Childhood Pneumococcal Immunization. Ann Intern Med. 2006;144:1-9. doi: 10.7326/0003-4819-144-1-200601030-00004
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Published: Ann Intern Med. 2006;144(1):1-9.
Apneumococcal conjugate vaccine containing 7 serotypes was recommended for routine use in infants in the United States beginning in 2000 (1). Widespread use of the vaccine caused steep declines in invasive pneumococcal disease among young children (2-4) and was associated with decreased disease attributable to vaccine serotypes among adults, for whom the vaccine is not licensed (3). Effects on disease among unvaccinated persons, often called herd effects, are presumably due to reduced transmission from immunized children. Because 90 pneumococcal serotypes cause human disease, there were concerns that the introduction of a conjugate vaccine containing 7 serotypes would lead to increased disease caused by nonvaccine-type organisms, a phenomenon called serotype replacement. Early postintroduction surveillance showed limited serotype replacement disease in the target age group, with no consistent trend toward increasing disease caused by nonvaccine serotypes among adults (3). To our knowledge, the effects of pediatric use of pneumococcal conjugate vaccine on immunocompromised adults, including those infected with HIV, have not previously been investigated.
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Infectious Disease, HIV, Streptococcal Infections, Prevention/Screening.
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