Are current recommendations for pneumococcal vaccination appropriate for Western Australia?

Objective: To examine the epidemiology of invasive pneumococcal disease (IP D) in Western Australia (WA), and thereby to assess whether current Austral ian recommendations on vaccination are suitable for WA and whether vaccines cover the local IPD-causing serotypes. Design and setting: Prospective laboratory surveillance, with data gathered on all people in WA who had Streptococcus pneumoniae (pneumococcus) isolat ed from a normally sterile body site, 1 April 1996 to 1 April 1997. Main outcome measures: IPD incidence and mortality rates, risk factors, cli nical presentation and disease-causing serotypes, Results IPD incidence and mortality were higher in the Indigenous than non- indigenous population (relative risk [RR] for incidence, 11.9; 95% CI, 6.8- 14.9, P<0.001; RR for mortality, 22.7; 95% CI, 7.2-71.3, P<0.001), but the case-fatality rate did not differ significantly Incidence increased signifi cantly from the ages of 25 years in Indigenous people and 60 years in non-i ndigenous people. Most disease-causing isolates from adults (94% from non-i ndigenous and 86% from Indigenous adults) belonged to serotypes included in the current 23-valent vaccine. Thirty-one isolates (92%) from non-indigeno us children (aged <15 years) belonged to serotypes included in the new seve n-valent conjugate vaccine, compared with only five (50%) from Indigenous c hildren (chi(2)=9.7; P<0.001) Conclusions: Current Australian vaccination recommendations do not appear t o match IPD epidemiology in WA; consideration should be given to lowering t he age criterion for vaccination to 25 years for Indigenous and 60 years fo r non-indigenous people. The new seven-valent conjugate Vaccine may not ade quately cover disease-causing serotypes in Indigenous children.