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.doc

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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