Vaccine reduces racial disparity in incidence of childhood pneumonia and meningitis

05/06/04

A vaccine that was distributed beginning in 2000 has reduced the incidence of childhood pneumonia and meningitis and has helped to decrease the excess incidence among black Americans, according to a study in the May 12 issue of The Journal of the American Medical Association (JAMA).

"Historically, blacks in the United States have higher incidence of invasive pneumococcal disease (i.e., pneumonia and meningitis) than whites, with the widest disparities occurring among children in the first 2 years of life and among adults 18 to 64 years old," according to background information in the article. Following recommendation of a new vaccine (7-valent pneumococcal conjugate vaccine) for children in October 2000, the incidence of invasive pneumococcal disease has declined dramatically, but the impact of vaccination on racial disparities in incidence of pneumococcal disease has not been known.

Brendan Flannery, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues analyzed data from the Active Bacterial Core Surveillance (ABCs)/Emerging Infections Program Network, an active, population-based surveillance system in 7 states. The data included 15,923 cases of invasive pneumococcal disease occurring between January 1, 1998, and December 31, 2002.

The researchers found that between 1998 and 2002, annual incidence rates for invasive pneumococcal disease decreased from 19.0 to 12.1 cases per 100,000 among whites and from 54.9 to 26.5 among blacks. "Due to these declines, 14,730 fewer cases occurred among whites and 8,780 fewer cases occurred among blacks in the United States in 2002, compared with the average number in two prevaccine years, 1998 and 1999. Before vaccine introduction, incidence among blacks was 2.9 times higher than among whites; in 2002, the black-white rate ratio had been reduced to 2.2. Incidence among black children younger than 2 years went from being 3.3 times higher than among white children in the prevaccine period to 1.6 times higher in 2002," the authors write.

By 2002, 74 percent of white children and 68 percent of black children aged 19 to 35 months in the 7 states had received at least 1 dose of pneumococcal conjugate vaccine; 43 percent of white and 39 percent of black children received three or more doses.

"While the cause of the excess pneumococcal disease burden observed in black Americans remains unclear, the use of pneumococcal conjugate vaccine is clearly an important tool for reducing this excess risk," the researchers conclude.

(JAMA. 2004;291:2197-2203. Available post-embargo at JAMA.com)

Editor's Note: Financial support for this project was provided by the CDC Emerging Infections Program.

EDITORIAL: RACE-BASED IMMUNIZATION RECOMMENDATIONS AND THE POTENTIAL TO REDUCE HEALTH DISPARITIES

In an accompanying editorial, Mathew M. Davis, M.D., M.A.P.P., of the University of Michigan, Ann Arbor, Mich., writes that the key to dramatic reductions in pneumococcal disease across all age groups has been the opportunity to immunize many individuals in the age group most at risk for the illness--children younger than 2 years--with this new, effective vaccine.

"For the immediate future, pneumococcal prophylaxis for nonelderly high-risk adults can continue to rest principally on herd immunity conveyed by infants receiving [7-valent pneumococcal conjugate vaccine] in ever greater numbers. Alternatively, those adults and their clinicians can be challenged to match the children, shot for shot. With the former approach, racial disparities in disease incidence may continue to decline among children but may stall among adults. If the latter strategy is pursued, entire communities stand to gain, regardless of their background," he writes.

(JAMA. 2004;291:2253-2254. Available post-embargo at JAMA.com)

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