Pneumococcal disease mortality in the United States, 1990--2004

Streptococcus pneumoniae causes significant mortality in the U.S. Before pneumococcal conjugate vaccine (PCV7) was introduced, approximately 40,000 deaths occurred each year in the U.S. due to pneumococcal infection. Childhood mortality decreased following widespread use of PCV7. Despite decreases in pneumococcal disease incidence in adults, one study found that mortality rates did not change proportionately. A study examining pneumococcal-related mortality in all persons in the U.S. is needed to understand the burden S. pneumoniae places on society.; Deaths were selected from Multiple-Cause-of-Death data files, 1990-2004. Linear regression was used to assess age and temporal trends of all pneumococcal-related deaths and, specifically, pneumococcal meningitis-related deaths and pneumococcal septicemia-related deaths. The impact of PCV7 was also evaluated. Seasonal differences in pneumococcal-related deaths were assessed using the chi-square test. Logistic regression analysis was performed to examine the association between comorbid diseases and pneumococcal-related deaths.; This study demonstrates that pneumococcal disease continues to be an important cause of preventable mortality in the U.S. Young adult males continue to experience higher mortality rates than females despite improvements in post-PCV7 mortality rates. Age-specific mortality rates follow that of pneumococcal disease incidence. The decreasing trend in pneumococcal-related mortality occurring before the introduction of PCV7 in the U.S. continued after 2001, especially for pneumococcal meningitis mortality and pneumococcal septicemia mortality. Although overall mortality rates of other race/ethnic groups approach that of Caucasians, this is not the case for all age groups-mortality in Asian/Pacific Islander children and American Indian/Alaskan Native elderly was much higher than mortality in Caucasians during the post-PCV7 time period. Conditions found to be associated with pneumococcal mortality were chronic liver disease, asplenia, HIV, non-HIV immunocompromising conditions, and chronic pulmonary disease. The level of association of these conditions with pneumococcal mortality varied according to age and time period.; The continuing burden of pneumococcal mortality underscores the importance of expanding prevention efforts and tailoring interventions according to age and race/ethnicity, as well as the presence of certain comorbid conditions.