Decreasing case fatality rate following invasive pneumococcal disease, North East England, 2006–2016

C. Houseman, K. E. Chapman, P. Manley, Russell Gorton, D. Wilson, G. J. Hughes*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

Declining mortality following invasive pneumococcal disease (IPD) has been observed concurrent with a reduced incidence due to effective pneumococcal conjugate vaccines. However, with IPD now increasing due to serotype replacement, we undertook a statistical analysis to estimate the trend in all-cause 30-day case fatality rate (CFR) in the North East of England (NEE) following IPD. Clinical, microbiological and demographic data were obtained for all laboratory-confirmed IPD cases (April 2006–March 2016) and the adjusted association between CFR and epidemiological year estimated using logistic regression. Of the 2510 episodes of IPD included in the analysis, 486 died within 30 days of IPD (CFR 19%). Increasing age, male sex, a diagnosis of septicaemia, being in ≥1 clinical risk groups, alcohol abuse and individual serotypes were independently associated with increased CFR. A significant decline in CFR over time was observed following adjustment for these significant predictors (adjusted odds ratio 0.93, 95% confidence interval 0.89–0.98; P = 0.003). A small but significant decline in 30-day all-cause CFR following IPD has been observed in the NEE. Nonetheless, certain population groups remain at increased risk of dying following IPD. Despite the introduction of effective vaccines, further strategies to reduce the ongoing burden of mortality from IPD are needed.

Original languageEnglish
Article numbere175
JournalEpidemiology and Infection
Volume147
DOIs
Publication statusPublished - 2019

Bibliographical note

Funding Information:
We thank the Public Health England North East Health Protection Team for their participation in IPD enhanced surveillance, the Public Health England Respiratory and Vaccine Preventable Bacteria Reference Unit for providing serotype results, all North East National Health Service microbiology laboratories for reporting cases of IPD, teams from primary care and acute National Health Service trusts across NEE for providing enhanced surveillance and Nick Hinton for undertaking linkage to death data. This work was supported by a grant from the Health Protection Agency Strategic Research and Development Fund, April 2009?March 2012; an unrestricted educational grant from Sanofi Pasteur MSD (UK12C1036), April 2012?June 2014; and an unrestricted grant from Pfizer UK Ltd (WI194024), August 2015. The funders had no role in the study design, data collection and analysis or manuscript preparation.

Funding Information:
Financial support. This work was supported by a grant from the Health Protection Agency Strategic Research and Development Fund, April 2009– March 2012; an unrestricted educational grant from Sanofi Pasteur MSD (UK12C1036), April 2012–June 2014; and an unrestricted grant from Pfizer UK Ltd (WI194024), August 2015. The funders had no role in the study design, data collection and analysis or manuscript preparation.

Publisher Copyright:
© The Author(s) 2019.

Keywords

  • Case fatality rate
  • Invasive pneumococcal disease
  • Mortality
  • Pneumococcal infection
  • Pneumococcal vaccine
  • Streptococcus pneumoniae

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