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Meningococcal conjugate vaccines were licensed beginning in 2005 on the basis of serologic end points and recommended for use in adolescents. A single dose at age 11 to 12 years was expected to provide protection through late adolescence. We conducted a case-control evaluation of vaccine effectiveness (VE) and duration of protection of a meningococcal (groups A, C, W, and Y) polysaccharide diphtheria toxoid conjugate vaccine (MenACWY-D). Cases of culture- or polymerase chain reaction-confirmed serogroup A, C, W, and Y meningococcal disease among adolescents were identified through meningococcal disease surveillance sites in the United States from January 1, 2006, through August 31, 2013. Attempts were made to enroll 4 friend and school controls per case. VE was calculated using the generalized estimating equation, controlling for underlying medical conditions and smoking. Serogroup C accounted for 88 (49%), serogroup Y 80 (44%), and serogroup W 13 (7%) of enrolled cases. Thirty-six (20%) cases and 87 (44%) controls received MenACWY-D. The overall VE estimate 0 to 8 years postvaccination was 69% (51% to 80%); VE was 79% (49% to 91%) at

BackgroundIn 2000, seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in the USA and resulted in dramatic reductions in invasive pneumococcal disease (IPD) and moderate increases in non-PCV7 type IPD. In 2010, PCV13 replaced PCV7 in the US immunisation schedule. We aimed to assess the effect of use of PCV13 in children on IPD in children and adults in the USA.MethodsWe used laboratory-based and population-based data on incidence of IPD from the Active Bacterial Core surveillance (part of the Centers for Disease Control and Prevention's Emerging Infections Program) in a time-series model to compare rates of IPD before and after the introduction of PCV13. Cases of IPD between July 1, 2004, and June 30, 2013, were classified as being caused by the PCV13 serotypes against which PCV7 has no effect (PCV13 minus PCV7). In a time-series model, we used an expected outcomes approach to compare the reported incidence of IPD to that which would have been expected if PCV13 had not replaced PCV7.FindingsCompared with incidence expected among children younger than 5 years if PCV7 alone had been continued, incidence of IPD overall declined by 64% (95% interval estimate [95% IE] 59-68) and IPD caused by PCV13 minus PCV7 serotypes declined by 93% (91-94), by July, 2012, to June, 2013. Among adults, incidence of IPD overall also declined by 12-32% and IPD caused by PCV13 minus PCV7 type IPD declined by 58-72%, depending on age. We estimated that over 30 000 cases of IPD and 3000 deaths were averted in the first 3 years after the introduction of PCV13.InterpretationPCV13 reduced IPD across all age groups when used routinely in children in the USA. These findings provide reassurance that, similar to PCV7, PCVs with additional serotypes can also prevent transmission to unvaccinated populations.FundingCenters for Disease Control and Prevention.

BackgroundStreptococcus pneumoniae continues to cause a variety of common clinical syndromes, despite vaccination programs for both adults and children. The total U.S. burden of pneumococcal disease is unknown.MethodsWe constructed a decision tree-based model to estimate U.S. healthcare utilization and costs of pneumococcal disease in 2004. Data were obtained from the 2004-2005 National (Hospital) Ambulatory Medical Care Surveys (outpatient visits, antibiotics) and the National Hospital Discharge Survey (hospitalization rates), and CDC surveillance data. Other assumptions regarding the incidence of each syndrome due to pneumococcus, expected health outcomes, and healthcare utilization were derived from literature and expert opinion. Healthcare and time costs used 2007 dollars.ResultsWe estimate that, in 2004, pneumococcal disease caused 4.0 million illness episodes, 22,000 deaths, 445,000 hospitalizations, 774,000 emergency department visits, 5.0 million outpatient visits, and 4.1 million outpatient antibiotic prescriptions. Direct medical costs totaled $3.5 billion. Pneumonia (866,000 cases) accounted for 22% of all cases and 72% of pneumococcal costs. In contrast, acute otitis media and sinusitis (1.5 million cases each) comprised 75% of cases but only 16% of direct medical costs. Patients ≥ 65 years old, accounted for most serious cases and the majority of direct medical costs ($1.8 billion in healthcare costs annually). In this age group, pneumonia caused 242,000 hospitalizations, 1.4 million hospital days, 194,000 emergency department visits, 374,000 outpatient visits, and 16,000 deaths. However, if work loss and productivity are considered, the cost of pneumococcal disease among younger working adults (18-

Objective To compare sentinel and population-based surveillance of the effect of seven-valent pneumococcal conjugate vaccine (PCV7), introduced in 2000, on the hospitalization of children aged under 5 years with invasive pneumococcal disease (IPD) in the United States of America. Methods Population surveillance data were used to identify children hospitalized between 1998 and 2006 with IPD caused by Streptococcus pneumoniae serotypes. The change from 1998 and 1999 (baseline) to 2006 in the number of hospitalized IPD cases recorded by sentinel surveillance systems involving single hospitals or groups of hospitals was compared with the change in the incidence of hospitalized IPD cases measured by population-based surveillance. Findings The change in incidence in the eight surveillance areas varied from -37 to -82% for IPD caused by any serotype and from -96 to -100% for IPD caused by serotypes contained in PCVT. All individual sentinel hospitals with more than three cases annually at baseline reported a decrease in cases by 2006. In addition, over 95% of sentinel systems with an average of more than 30 cases annually at baseline recorded a change by 2006 in the number of cases caused by any serotype that fell within the 95% confidence interval for the change in the incidence of hospitalized cases in the corresponding population surveillance area. The change in cases caused by PCV7 serotypes was accurately measured by 93% and 100% of sentinel systems with ≤ 20 and > 20 cases annually at baseline, respectively. Conclusion Sentinel surveillance can accurately measure the effect of PCV7 on the number of children hospitalized with IPD, provided sufficient cases are detected at baseline. Serotyping increases accuracy. Objectif Comparer le suivi d'un echantillon sentinelle et de la population quant a l'effet d'un vaccin conjugue pneumococcique heptavalent (PCV7), lance en l'an 2000, sur l'hospitalisation d'enfants ages de moins de 5 ans, atteints d'infection invasive a pneumocoques (IIP) aux Etats Unis d'Amerique. Methodes Les donnees de suivi de la population ont ete utilisees pour identifier les enfants hospitalises entre 1998 et 2006, souffrant d'IIP causees par les serotypes de Streptococcus pneumoniae. L'evolution entre 1998-1999 (niveau de depart) et 2006, du nombre de cas d'IIP hospitalises enregistres par les systemes de surveillance sentinelle, impliquant des hopitaux individuels ou des groupes d'hopitaux, a ete comparee a la variation d'incidence des cas d'IIP hospitalises mesures par l'epidemiosurveillance de la population. Resultats La variation de l'incidence dans les 8 zones de surveillance oscillait de -37% a -82% pour les IIP causees par n'importe quel serotype et de -96% a -100% pour les IIP engendrees par les serotypes contenus dans le PCV7. Tous les hopitaux sentinelles individuels rapportant plus de 3 cas par an au depart ont fait etat d'une diminution des cas en 2006. En outre, plus de 95% des systemes sentinelles presentant une moyenne de plus de 30 cas par an au depart ont enregistre un changement en 2006 du nombre de cas causes par tout serotype, respectant l'intervalle de confiance de 95% en regard de la variation de l'incidence des patients hospitalises dans la zone de surveillance de la population correspondante. Levolution du nombre de cas causes par les serotypes PCV7 a ete mesuree avec une precision de 93% et de 100% par les systemes sentinelles presentant respectivement [menor que o igual a] 20 et >20 cas par an au depart. Conclusion La surveillance sentinelle peut mesurer avec precision l'effet du PCV7 sur le nombre d'enfants hospitalises pour IIP, a condition qu'un nombre suffisant de cas soient detectes au depart. Le serotypage augmente cette exactitude. Objetivo Comparar los resultados de un sistema de vigilancia centinela y un sistema de vigilancia poblacional acerca del efecto de la vacuna antineumococica conjugada 7-valente (PCV7), presentada en el ano 2000, en la hospitalizacion de ninos de edad inferior a 5 anos con enfermedad neumococica invasiva (ENI) en los Estados Unidos de America. Metodos Los datos del sistema de vigilancia poblacional se emplearon para identificar a los ninos hospitatizados con ENI provocada por los serotipos de Streptococcus pneumoniae entre los anos 1998 y 2006. El cambio desde 1998 y 1999 (linea de referencia) hasta 2006 en el numero de casos de ENI hospitalizados y registrados a traves de sistemas centinela en hospitales individuales o grupos de hospitales se comparo con el cambio en la incidencia de casos de ENI hospitalizados medidos a traves del sistema de vigilancia poblacional. Resultados El cambio en la incidencia en las ocho areas de control vario de un -37 a un -82% para los casos de ENI provocados por cualquier serotipo, y de un -96 a un -100% para las ENI provocadas por los serotipos incluidos en PCV7. Todos los hospitales centinela individuales con mas de tres casos anuales en el ano de referencia registraron un descenso de casos para el ano 2006. Ademas, mas del 95% de los sistemas centinela con una media superior a 30 casos anuales en el ano de referencia registraron un cambio para el ano 2006 en cuanto al numero de casos provocados por cualquier serotipo, que descendio al 95% del intervalo de confianza para el cambio en la incidencia de casos hospitalizados en el area de control de la poblacion correspondiente. El cambio en los casos provocados por los serotipos PCV7 se midio de manera precisa en el 93% y el 100% de los sistemas centinela con [menor que o igual a] 20 y > 20 casos anuales en el ano de referencia, respectivamente. Conclusion El sistema de vigilancia centinela puede medir de manera precisa el efecto de la PCV7 en el numero de ninos hospitalizados con ENI, siempre y cuando se hayan detectado casos suficientes en el ano de referencia. El serotipado aumenta la precision., Introduction Every year Streptococcus pneumoniae, or pneumococcus, causes an estimated 826 000 deaths worldwide in children under 5 years of age. (1) In 2000, a seven-valent pneumococcal conjugate vaccine (PCV7) [...]

A study was conducted to as per national guidelines formulated in 2002 to screen pregnant women for colonization with group B streptococcus that could indicate the development of the disease in infants within a week after birth. Results revealed that universal screening proved to be useful in identifying mothers with group B streptococcus and could help in management of the condition in the newborns.

A study is conducted to evaluate the efficacy of prevention guidelines in helping reduce the incidence of invasive Group B Streptococcal disease in the U.S. from 1999 to 2005. Results indicate a reduction in mortality among children from invasive Group B Streptococcal disease while on the other hand it had no effect on adults with the same disease.

The study presents the incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) disease in the U.S. The results show that invasive MSRA infections affect certain populations disproportionately and are no longer restricted to medical settings only.

Five of seven serotypes in the pneumococcal conjugate vaccine, introduced for infants in the US in 2000, are responsible for most penicillin-resistant infection thus a study is conducted to examine the effect of this vaccine on invasive disease caused by resistant strains. The examination revealed that rate of antibiotic-resistant invasive pneumococcal infections decreased in young children and older persons after the introduction of the conjugate vaccine, while there is an increase in infections caused by serotypes not included in the vaccine.

The Africans in the United States are more prone to invasive pneumococcal disease than the Americans. There is a decline in invasive disease among the younger children because of the introduction of a new protein polysaccharide pneumococcal conjugate vaccine.

Community-specific antimicrobial susceptibility data may help monitor trends among drug-resistant Streptococcus pneumoniae and guide empiric therapy. Because active, population-based surveillance for invasive pneumococcal disease is accurate but resource intensive, we [...]

We collected data during postexposure antimicrobial prophylaxis campaigns and from a prophylaxis program evaluation 60 days after start of antimicrobial prophylaxis involving persons from six U.S. sites where Bacillus anthracis [...]

Testing all pregnant women for group B streptococcal infection will prevent more streptococcal infections in their babies than a risk-based approach, according to a study of 629,912 live births. This is the so-called screening approach, whereas the risk-based approach tries to predict which women might be infected based on their risk factors.

We used population-based data to evaluate how often groups of randomly selected clinical laboratories accurately estimated the prevalence of resistant pneumococci and captured trends in resistance over time. Surveillance for [...]