Invasive pneumococcal disease in the population of Victoria

Objectives: To estimate morbidity and mortality rates for invasive Streptoc occus pneumaniae (pneumococcal) disease in the non-indigenous population of Victoria.; Design and setting: Survey using data from a statewide voluntary laboratory surveillance scheme (1989-1998), statewide hospital discharge database (19 95-1998), medical records of notified patients (1994-1995) and serotyping o f notified isolates (1994-1998). Main outcome measures: Incidence of pneumococcal bacteraemia and pneumonia; predisposing factors; serotypes of isolates, Results: Minimum estimates of annual incidence of invasive disease, based o n laboratory surveillance data for 1995-1998, were 59 per 100 000 for child ren aged < 2 years, 25 per 100 000 for people aged greater than or equal to 65 years, and 8: per 100 000 overall, Annual incidence of pneumococcal pne umonia, calculated from hospital discharge data, was 99 per 100 000 for tho se aged a 65 years. Manifestations of invasive pneumococcal disease varied with age, with meningitis more common in infants, and pneumonia most common in older patients. A predisposing factor for pneumococcal infection was pr esent in 48% of patients. Most isolates from infants (83%) belonged to sero types in the proposed seven-valent infant vaccine, and 91% of isolates from people aged greater than or equal to 2 years belonged to serotypes in the current 23-valent adult vaccine. Conclusions: S, pneumoniae continues to be a major cause of morbidity and m ortality in young children and the elderly in Victoria; More widespread use of the currently available pneumococcal vaccine in adults and introduction of an effective vaccine for infants should greatly reduce incidence of the disease.