1. Serotype 10A in Invasive Pneumococcal Disease (IPD) Surveillance in New Jersey, April – September 2009
Samantha Pitts, MD, MPH
CDC/CSTE Applied Epidemiology Fellow
New Jersey Department of Health and Senior Services (NJDHSS)

2. IPD in New Jersey In New Jersey, IPD is reportable in all age groups
Case definition: documented S. pneumoniae infection from a normally sterile site and clinical symptoms
Hospitals and local health departments report confirmed cases annually

3. New Jersey vaccination requirements for child care and preschool entry
Children 2-11 months: 2 doses of pneumococcal conjugate vaccine (PCV)
Children months: 1 dose of PCV after their first birthday

4. Background
Emergence of serotype replacement following introduction of PCV-7
Increase in reported cases in multiple New Jersey counties in
Received anecdotal reports of severe IPD in persons at low risk
Pilot study initiated to evaluate extent of serotype replacement in New Jersey

5. Methods
Beginning April 1, 2009, NJDHSS requested that clinical laboratories submit all IPD specimens to state laboratory
Serotyping done by PCR-based method
Case reports were matched to laboratory samples for analysis
Study case definition did not require documentation of clinical symptoms

6. Results: Case Ascertainment April – September 2009
150 (51%) case-persons with specimen for serotyping
143 (48%) case-persons used in analysis
6 (2%) failed to grow
1 (0.3%) not consistent with S. pneumoniae
296 reported IPD cases

7. 1 Personal communication, Ruth Link-Gelles, CDC, 2011
Serotype Distribution in NJ vs. Active Bacterial Core Surveillance (ABCs) Data from 20091
PCV-13
PPSV-23 0% 5%
10%
15%
20%
25%
30%
19A 7F 3
10A
22F
33F 9N 6C
15A
23A
16F
New Jersey
ABCs
Percent
Serotype
1 Personal communication, Ruth Link-Gelles, CDC, 2011

8. Age Distribution of Serotype 10A Compared with Other Serotypes
P=.10 by Fisher’s exact test

9. Geographic Distribution of 10A IPD in NJ

10. Geographic Distribution of All IPD in NJ
Other

11. IPD serotype in NJ, April – September 2009, by MMWR week5 10 15 20 25 30 35
13-15
16-18
19-21
22-24
25-27
28-30
31-33
34-36
37-39
MMWR week
Count 0% 5%
10%
15%
20%
25%
30%
35%
40%
45%
Percent
Other serotypes
Serotype 10A
Serotype 10A (percent of IPD)

12. Severity of cases in NJ, April – September 2009
ICU Admission
Serotype 10A
(n=36)
Other serotypes (n=107)
p value
28%
32%
.58
Death
Serotype 10A
(n=23)
Other serotypes (n=72)
p value
26%
11%
.10

13. Discussion Laboratory error Selection bias Outbreak
Approximately 20% of 10A tested by conventional serotyping
All were confirmed as 10A
Selection bias
Outbreak
Seasonal phenomenon
Regional difference in serotype distribution

14. Conclusions Serotype 10A represented 25% of IPD in NJ
Serotype 10A has not been reported to represent a substantial percentage of IPD in the US
May represent an opportunity for further prevention as serotype 10A is included in the polysaccharide vaccine
State-based serotyping may be useful

15. Limitations
Specimens were obtained during only 6 months of surveillance
Only a subset (48%) of reported cases during this period had a specimen available for analysis
Surveillance for IPD in NJ relies on passive reporting

16. Next Steps A case control study is underway to:
Determine case vaccination eligibility and vaccination status
Evaluate disease severity
Continued serotype testing as part of IPD surveillance would help to determine if serotype 10A persists

17. Coauthors and Acknowledgements
NJDHSS:
Lisa McHugh
Christina Tan
Nelson Delgado
Sarmila DasGupta
Thomas Kirn
Corey Robertson
Cindy Gross
Andria Apostolou
NJDHSS, cont.:
Barbara Montana
Faye Sorhage
Erica Rauch
Amy Fink
Stella Tsai
Centers for Disease Control and Prevention:
Matt Moore
Ruth Link-Gelles