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2004 Indiana Report of Infectious Diseases

Pneumococcal, Invasive Disease

Table 1. Pneumococcal Disease Cases by Race and Sex, Indiana, 2004
  2004 2000-2004
Cases Rate* Cases
Total 575 9.22 3,181
Race
   White 413 7.47 2,158
   Black 64 11.67 481
   Other 1 0.63 6
   Not Reported 97 - 536
Sex
   Male 276 8.99 1,576
   Female 297 9.37 1,589
   Not Reported 2 - 16

*Rate per 100,000 population based on the U.S. Census Bureau’s   population data as of July 1, 2004

Pneumococcal disease is caused by the bacterium Streptococcus pneumoniae and results in widespread illness and death in the United States. The major clinical syndromes of pneumococcal disease include pneumonia, bacteremia, and meningitis. Pneumococcal bacteria, of which there are over 90 serotypes, are common inhabitants of the respiratory tract.

Surveillance of invasive pneumococcal disease has been ongoing in Indiana since the summer of 1998. Figure 1 shows the number of reported cases per year for 2000-2004. In 2004, 575 cases of pneumococcal disease were reported in Indiana, for a case rate of 9.22 per 100,000 population. Disease incidence was greatest during the winter and early spring months (Figure 2). Incidence of invasive pneumococcal disease varies considerably with age. In 2004, the age-specific rates were highest in adults aged 80 years and older (47.26), followed by infants less than 1 year of age (25.55) (Figure 3). In 2004, the incidence rate among the black population (11.67) was more than that of the white population (7.47) as can be seen in Table 1. The difference in rates between genders was not significant.

In 2004, 74 counties reported at least 1 case of invasive pneumococcal disease, with 29 counties reporting 5 or more cases. The incidence rates were highest among the following counties reporting five or more cases: Grant (32.1), Clay (25.7), and Gibson (24.0). Cases are widely distributed geographically as can be seen in Figure 4. Only counties reporting five or more cases are represented.

Drug-Resistant Streptococcus pneumoniae (DRSP)

Antibiotic resistance has become an emerging world, national, and state problem in the treatment of pneumococcal disease. In the U.S., DRSP has increased substantially over the past 15 years; DRSP varies regionally and has been reported to be over 30 percent in some areas of the U.S.

Sensitivity data can be compared from year to year to determine if the organism is becoming more or less resistant to various antibiotics. Table 2 shows selected antibiotics and rates of resistance reported for 2000-2004. As can be seen in Table 2, the percent of isolates that are resistant have remained stable for the five-year period.

Table 2:  Antimicrobial Resistance Rate of Selected Antibiotics (either high or intermediate level resistance), Indiana, 2000-2004
Antimicrobial Agent 2000 2001 2002 2003 2004
No. Tested % Resistant No. Tested % Resistant No. Tested % Resistant No. Tested % Resistant No. Tested % Resistant
Penicillin 632 32% 585 31% 593 24% 522 25% 485 28%
Cefotaxime 303 15% 295 19% 275 8% 277 5% 236 3%
Chloramphenicol 228 7% 241 4% 231 1% 154 3% 106 3%
Clindamycin 82 6% 104 6% 113 0% 84 2% 51 8%
Erythromycin 321 30% 309 30% 343 26% 269 25% 304 34%
Levofloxacin 127 3% 229 <1% 266 3% 317 2% 311 1%

Trimethoprim/
Sulfamethoxazole

 287 35% 301 33% 328 33% 260 28% 276 26%
Vancomycin 504 0% 507 0% 487 0% 474 0% 464 0%

You can learn more about pneumococcal infections by visiting the following Web sites:
http://www.IN.gov/isdh/healthinfo/pneumococcal%20infections.htm
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/drugresisstreppneum_t.htm

 

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