Population-Based Surveillance for Invasive Pneumococcal Disease in Homeless Adults in Toronto 英文参考文献.docVIP
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Population-Based Surveillance for Invasive Pneumococcal Disease in Homeless Adults in Toronto 英文参考文献
Population-BasedSurveillanceforInvasive
PneumococcalDiseaseinHomelessAdultsinToronto
AgronPlevneshi1,2,TomislavSvoboda3,IreneArmstrong4,GregoryJ.Tyrrell1,5,AnnaMiranda4 ,Karen
Green1,2,DonaldLow1,2,AllisonMcGeer1,2*fortheTorontoInvasiveBacterialDiseasesNetwork¤
1TorontoInvasive Bacterial Diseases Network, Toronto, Ontario, Canada, 2Department of Microbiology, Mount Sinai Hospital,Toronto, Ontario, Canada, 3Centrefor
ResearchonInnerCityHealth,St.Michael’sHospital,Toronto,Ontario,Canada,4CityofTorontoPublicHealthDepartment,Toronto,Ontario,Canada,5CanadianNational
CentreforStreptococcus,Edmonton,Alberta,Canada
Abstract
Background: Identification of high-risk populations for serious infection due to S. pneumoniae will permit appropriately
targetedpreventionprograms.
Methods: We conducted prospective, population-based surveillance for invasive pneumococcal disease and laboratory
confirmedpneumococcalpneumoniainhomelessadultsinToronto,aCanadiancitywithatotalpopulationof2.5M,from
January1,2002toDecember31,2006.
Results: We identified 69 cases of invasive pneumococcal disease and 27 cases of laboratory confirmed pneumococcal
pneumoniainanestimatedpopulationof5050homelessadults.Theincidenceofinvasivepneumococcaldiseaseinhomeless
adultswas273infectionsper100,000personsperyear,comparedto9per100,000personsperyearinthegeneraladult
population.Homelesspersonswithinvasivepneumococcaldiseasewereyoungerthanotheradults(medianage46yearsvs
67years,P,.001),andmorelikelythanotheradultstobesmokers(95%vs.31%,P,.001),toabusealcohol(62%vs15%,
P,.001),andtouseintravenousdrugs(42%vs4%,P,.001).Relativetoagematchedcontrols,theyweremorelikelytohave
underlyinglungdisease(12/69,17%vs17/272,6%,P=.006),butnotmorelikelytobeHIVinfected(17/69,25%vs58/282,21%,
P=.73).Theproportionofpatientswithrecurrentdiseasewasfivefoldhigherforhomelessthanotheradults(7/58,12%vs.24/
943, 2.5%, P,.001). In homeless adults, 28 (32%) of pneumococcal isolates were of serotypes included in the 7-valent
conjugatevaccine,42(4
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