Epidemiology of invasive pneumococcal disease in the era of childhood vaccination: Newark, New Jersey

Background: Newark has an estimated population of 273,000; 53% are Black and 29.5% are Hispanic. Approximately 6000(2%) of Newark residents are living with HIV. Since the introduction of the conjugated Streptococcus pneumoniae (pneumococcal) vaccine, national declines in invasive pneumococcal disease (IPD) have been reported. However, the local epidemiology of IPD in under-immunized populations with substantial HIV(+) prevalence, such as Newark, has not been described. Objective: To describe the epidemiology of IPD in Newark. Methods: Cases of IPD, a reportable condition, in Newark residents from October 2003 and 2006 were analyzed using SPSS. Results: Of 163 reported cases, 144 were confirmed in Newark residents. 42% of cases occurred in adults aged 40 to 49 years (median age, 45, range 6 months to 87 years). Race/ethnicity of cases included 16(11%) Hispanic, 92(64%) Black, 9(6%) White, and 27 (19%) Other/Unknown. % IPD cases with documented HIV infection increased: 15% in 2004 and 2005; and 32% in 2006. Data for the year of 2003 is incomplete; mandated reporting IPD began in late 2003. 77% of the IPD cases with documented HIV infection were in females compared with 58% overall. Conclusion: In contrast to national declines, reported IPD may be increasing in Newark, with one in three recent cases among HIV-infected people, and over half among Blacks. Responding to this trend requires development of public health interventions, including vaccination programs targeting people living with HIV. Future analysis of serotype distribution is crucial to understanding any replacement disease by non-vaccine serotypes in this vulnerable population.