Epidemiology and High-Risk Populations for Pneumococcal Disease

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EP: 1.Epidemiology and High-Risk Populations for Pneumococcal Disease

EP: 2.Comparing Pneumococcal Vaccines and CDC Recommendations for Adults

EP: 3.Updated Evidence-Based Recommendations for Pneumococcal Conjugate Vaccines

EP: 4.Pharmacist’s Guide: Choosing the Most Appropriate Pneumococcal Vaccine for Patients

Pneumococcal Disease Epidemiology and High-Risk Populations Summary

Pneumococcal disease, caused by Streptococcus pneumoniae, represents a significant public health concern with distinct manifestations of varying severity. Non-invasive infections include otitis media, sinusitis, and pneumonia, with the majority of adult cases presenting as pneumonia. Community-acquired pneumonia cases are attributed to pneumococci in 10-30% of instances, resulting in over 150,000 hospitalizations annually. Invasive pneumococcal disease (IPD) occurs when bacteria enter the bloodstream, potentially causing meningitis or bacteremia. IPD is particularly severe and classified as a nationally notifiable disease, with cases tracked weekly by the CDC to monitor trends and inform vaccination policy decisions through the Advisory Committee on Immunization Practices.

The mortality statistics for pneumococcal disease are alarming, with bacterial meningitis cases showing a 14% case fatality ratio among older adults, meaning one in six infected individuals die. Pneumococcal bacteremia affects over 5,000 people yearly with a 12% fatality rate, translating to one in eight deaths among infected adults. In 2023 alone, more than 33,000 IPD cases resulted in 3,600 deaths. Age-based analysis reveals the highest case and death rates occur in individuals 65 years and older, followed by those aged 50-64 years. While pneumococcal pneumonia cases far exceed IPD in frequency, invasive infections carry substantially higher mortality risks.

Multiple risk factors elevate susceptibility to pneumococcal infections, with immunosenescence naturally increasing vulnerability as immune systems weaken with age. High-risk populations include those with compromised immune systems, including individuals with asplenia, chronic kidney failure, cerebrospinal fluid leaks, and cochlear implants. Additional risk factors encompass chronic conditions such as heart disease, diabetes, lung disease, liver disease, cigarette smoking, alcohol use disorder, and social circumstances like nursing home residence or homelessness. Functional or anatomic asplenia poses particularly elevated risk, increasing IPD likelihood up to 33-fold due to the spleen's crucial role in eliminating encapsulated bacteria.