Dynamic Epidemiology of Streptococcus pneumoniae- Joshua Metlay MD PhD
The Dynamic Epidemiology of Streptococcus pneumoniae. Joshua P. Metlay, MD, PhD Division of General Internal Medicine University of Pennsylvania Presented at the 41st Annual Symposium“Global Movement of Infectious Pathogens and Improved Laboratory Detection” Eastern PA Branch-American Society for Microbiology November 17, 2011 Thomas Jefferson University, Philadelphia
Outline• Introduction to pneumococcal disease• Secular trends –Antimicrobial drug resistance (macrolides) –Serotype replacement• Geographic patterns
Survival from pneumococcal bacteremia 1952-1962
Penicillin Resistance in S. pneumoniae United States 1979-2000 Sentinel ABCs1979-1994: CDC Sentinel Surveillance Network1995-2002: CDC Active Bacterial Core Surveillance (ABCs) /Emerging Infections Program
The Delaware Valley Hospital Network• Hospital based reporting of cases of pneumococcal bacteremia• Established in 2001• Centralized susceptibility testing• 48 hospitals in the 5 county region of Southeastern Pennsylvania• 3.7 million population• 400 annual cases
Participating hospitals in the Delaware Valley Emerging Infectious Diseases 2001
Why are there clusters of disease?• Small area outbreaks from highly virulent clones – Pathogen Hypothesis• Neighborhood level exposures influence risk of transmission – Vector Hypothesis• Heterogenous population distribution – Host Hypothesis
Child Exposure is Associated with Reduced Risk of DiseaseCharacteristic Cases per 100,000 95% CI# of children inhome 0 21.5 20.3 – 22.8 1 8.3 6.8 – 9.9 2+ 3.3 2.6 – 4.2 Archives of Internal Med 2010
Key Points• Overall risk of pneumococcal disease has declined but new serotypes are emerging• Emerging serotypes are primarily multidrug resistance, reflecting selection of MDR clones and expansion of previously low prevalence serotypes• Variation in disease risk likely reflects host factors, but vector and pathogen factors are rapidly changing in pneumococcal disease.
Thanks• Robert Austrian • Marshall Joffe• Lou Bell • Ebb Lautenbach• Catherine Berjohn • Yimei Li• Charlie Branas • Zhenying Liu• Linda Crossette • Russell Localio• Chris Czaja • Mat Macdonald• Paul Edelstein • Irv Nachamkin• Kristen Feemster • Samir Shah• Neil Fishman • Justine Shults• James Flory • Tony Smith
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