KEYWORDS:
Pneumococcal Disease, PPV, Community Intervention

BACKGROUND:
From 1998 through 2000 Monroe County (Monroe) conducted an intervention to increase pneumococcal vaccination (PPV) among adults aged >64 years. Interventions were conducted in primary and long-term care settings and public information campaigns were held each year. Six surrounding counties of the Rochester Metropolitan Statistical Area (RMSA) served as the comparison community.

OBJECTIVE(S):
To compare rates and serotypes of invasive pneumococcal disease (IPD) in Monroe and the RMSA over 4 years, July 1997 - June 2001.

METHOD(S):
Monroe and the RMSA counties participate in the Emerging Infections Program. Clinical and demographic data are collected for all laboratory confirmed cases of IPD and isolates are serotyped. Disease rates by age group were calculated using the 2000 census.

RESULT(S):
575 cases of IPD occurred in Monroe, of which 506 were serotyped, and 263 cases in RMSA (210 serotyped). The percent of adults >64 years in Monroe with PPV increased from 50% in 1997 to 73% in 2000. The overall rates for IPD were similar in Monroe and the RMSA, but for people >65 years rates were consistently lower in Monroe (average 48 vs. 62 per 100,000) but did not change significantly after the intervention. The percent of isolates covered by the PPV did not decline over time for the total group or for the highly vaccinated older adult population.

CONCLUSIONS(S):
IPD rates vary by year and age group and are affected by influenza outbreaks, which were moderate in 99-00 and mild in 00-01. Results suggest that widespread use of PPV contained IPD rates in older adults to below those in the comparison community and below the 1995-98 national average of 59.7 per 100,000. However, the effect of the vaccination intervention cannot be distinguished from other factors.

LEARNING OBJECTIVES:
To describe the difficulties in using disease outcomes to evaluate successful community-wide interventions.