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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e3181bdbed5
Original Studies

Invasive Pneumococcal Disease in Alaskan Children: Impact of the Seven-Valent Pneumococcal Conjugate Vaccine and the Role of Water Supply

Wenger, Jay D. MD*; Zulz, Tammy MPH*; Bruden, Dana MS*; Singleton, Rosalyn MD, MPH*; Bruce, Michael G. MD, MPH*; Bulkow, Lisa MS*; Parks, Debbie BS*; Rudolph, Karen PhD*; Hurlburt, Debby RN*; Ritter, Troy REHS, MPH†; Klejka, Joseph MD‡; Hennessy, Thomas MD, MPH*

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Background: Alaska Native (AN) children, especially those in the Yukon-Kuskokwim region (YK-AN children), suffer some of the highest rates of invasive pneumococcal disease (IPD) in the world. Rates of IPD declined after statewide introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2001, but increased in subsequent years.

Methods: Population-based laboratory surveillance data (1986–2007) for invasive Streptococcus pneumoniae infection in Alaskan children <5 years old were used to evaluate the association of IPD rates and serotype distribution with immunization, socioeconomic status, and in-home water service.

Results: Introduction of PCV7 vaccine resulted in elimination of IPD caused by vaccine serotypes, but was followed by increasing rates of IPD caused by nonvaccine serotypes. Among YK-AN children IPD rates dropped by 60%, but then rose due to non-PCV7 serotypes to levels 5- to 10-fold higher than rates in non-YK-AN children and non-AN children. IPD rates in YK-AN children were twice as high in villages where <10% of houses had in-home piped water compared with villages where more than 80% of houses had in-home piped water (390 cases/100,000 vs. 146 cases/100,000, P = 0.008).

Conclusions: High IPD rates in Alaska are associated with lack of in-home piped water (controlling for household crowding and per capita income). The effect of in-home piped water is most likely mediated through reduced water supply leading to limitations on handwashing.

© 2010 Lippincott Williams & Wilkins, Inc.


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