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Invasive Pneumococcal Disease

Invasive Pneumococcal Disease. Streptococcus pneumoniae. Clinical Syndromes. Meningitis: fever, headache, photophobia, nausea, vomiting, nuchal rigidity Bacteremia: fever, chills, (+/-)mental status or behavioral changes Pneumonia: fever, chills, productive cough, pleuritic chest pain

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Invasive Pneumococcal Disease

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  1. Invasive Pneumococcal Disease Streptococcus pneumoniae

  2. Clinical Syndromes • Meningitis: fever, headache, photophobia, nausea, vomiting, nuchal rigidity • Bacteremia: fever, chills, (+/-)mental status or behavioral changes • Pneumonia: fever, chills, productive cough, pleuritic chest pain • Otitis media: fever, ear pain, lack of appetite, irritability

  3. Conjugate Vaccine (2000)MMWR, 2000; 49 (No RR-9) • 7 serotypes of capsular polysaccharide (4, 9V, 14, 19F, 23F, 18C, 6B) linked to a protein carrier • Recommended for: • Children < 23 months • Children 24-59 months with • Sickle cell* or trait, beta-thalassemia, functional or anatomic asplenia* • HIV* • Chronic disease*, including chronic heart or lung disease, diabetes, or CSF leak; cochlear implant • Immunocompromising conditions* *revaccinate (23-valent polysaccharide vaccine after age 2)

  4. Polysaccharide vaccine (1983) MMWR, 1997; 46(No RR-8) • 23 polysaccharide antigens • Recommended for: • Persons > 65 years • Persons age 2-64 with: • Chronic heart or lung disease or diabetes; cochlear implant • Alcoholism, chronic liver disease or CSF leaks • Functional or anatomic asplenia* • Living in special environments or social settings • Immunocompromising conditions* *revaccinate

  5. MMWR, 2000, 49(No.RR-9)

  6. ISP Antimicrobial Resistance TrendsNEJM, 2000; 343:1917

  7. Case Definition • Clinical descriptionStreptococcus pneumoniae causes many clinical syndromes, depending on the site of infection (e.g., acute otitis media, pneumonia, bacteremia, or meningitis).  • Laboratory criteria for diagnosis Isolation of S. pneumoniae from a normally sterile site (e.g., blood, cerebrospinal fluid, or, less commonly, joint, pleural, or pericardial fluid)  • Case classification • Confirmed: a clinically compatible case caused by laboratory-confirmed culture of S. pneumoniae  from a normally sterile site 

  8. Public Health Action • Confirm the case • Use the supplemental form to guide you in asking important questions: • What was the site of infection? • Did the case have underlying disease? • What is the immunization status of the case? • Attach laboratory results and antimicrobial susceptibility studies

  9. Surveillance Q. I. (preliminary) – Invasive S pneumoniae

  10. Surveillance Q. I. (preliminary) – Invasive S pneumoniae

  11. Outbreak example

  12. Outbreak Example (2) • Pneumonia in 11 (13%) of 84 nursing home residents • 3 deaths • S pneumoniae serotype 23 F, • intermediate resistance to penicillin, cefotaxime; resistant to trimethoprim sulfamethoxazole and erythromycin; and sensitive only to vancomycin, rifampin and ofloxacin • 3 (4%) of residents had been vaccinated • 20 (27%) of 74 residents and 12 (17%) of 69 staff were colonized with the outbreak strain

  13. ISP - Summary • Risk • Highest in the very young and the very old • Vaccine-preventable disease • Antimicrobial resistance increasing • Investigation: • Site of infection • Vaccination history • Underlying disease • Antimicrobial resistance profile

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