Epidemiologic Relation between HIV and Invasive Pneumococcal Disease in San Francisco County, California

Article Abstract:

All HIV patients should receive the pneumococcal vaccine, which prevents infection by Streptococcus pneumoniae. In San Francisco, 54% of the 399 people diagnosed with pneumococcal infection during a three-year period were HIV patients. AIDS patients were 46 times more likely to develop pneumococcal infection than HIV-negative people. Black AIDS patients were five times more likely to develop pneumococcal infection than white AIDS patients. Pneumococcal infection was also more common in low-income areas. Eighty percent of the cases of pneumococcal infection could have been prevented by the pneumococcal vaccine.

Risk factors, Diseases, Pneumococcal infections, AIDS patients

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Cost-effectiveness of vaccination against invasive pneumococcal disease among people 50 through 64 years of age: role of comorbid conditions and race

Article Abstract:

Background: Guidelines are increasingly recommending preventive services starting at 50 years of age, and policymakers are considering such a recommendation for pneumococcal polysaccharide vaccination. The finding that pneumococcal vaccination is cost-saving for people 65 years of age or older raises the question of the vaccination?s implications for other older adults, especially black people, whose disease incidence exceeds that of nonblack people, and those with high-risk conditions. Objective: To assess the implications of vaccinating black and nonblack people 50 through 64 years of age against invasive pneumococcal disease. Design: Cost-effectiveness analysis. Data Sources: Published literature for vaccination effectiveness and cost estimates; data on disease incidence and case-fatality rates from the Centers for Disease Control and Prevention. Target Population: Hypothetical cohort 50 through 64 years of age with the 1995 U.S. age distribution. Time Horizon: Lifetime. Perspective: Societal. Intervention: Pneumococcal polysaccharide vaccination compared with no vaccination. Outcome Measures: Incremental medical costs and health effects, in quality-adjusted life-years per vaccinee. Results of Base-Case Analysis: Vaccination saved medical costs and improved health among high-risk black people ($27.55 savings per vaccinee) and nonblack people ($5.92 savings per vaccinee), excluding survivors? future costs. For low-risk black and nonblack people and the overall general population, vaccination cost $2477, $8195, and $3434, respectively, to gain 1 years of healthy life. Result Sensitivity Analysis: Excluding survivors? future costs, in the general immunocompetent population, cost per quality-adjusted life-year in global worst-case results ranged from $21 513 for black people to $68 871 for nonblack people; in the high-risk population, cost ranged from $11 548 for black people to $39 000 for nonblack people. In the global best case, vaccination was cost-saving for black and nonblack people in the general immunocompetent and high-risk populations, excluding survivors? future costs. The cost-effectiveness range was narrower in probabilistic sensitivity analyses, with 95% probabilistic intervals ranging from cost-saving to $1594 for black people and from cost-saving to $12 273 for nonblack people in the general immunocompetent population. Costs per quality-adjusted life-year for low-risk people with case-fatality rates from 1998 were $2477 for black people and $8195 for nonblack people, excluding survivors? medical costs. Conclusions: These results support the current recommendation to vaccinate high-risk people and provide useful information for considering extending the recommendation to the general population 50 through 64 years of age. Lack of evidence about the effectiveness of revaccination for people 65 years of age or older, when disease risks are higher, argues for further research to guide vaccination policy.

Economic aspects, Pneumococcal vaccine, Pneumococcal vaccines, Medical care, Cost of, Health care costs, Cost benefit analysis, Author Abstract

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Incidence and Clinical Implications of Isolation of Mycobacterium kansasii: Results of a 5-Year, Population-Based Study

Article Abstract:

Mycobacterium (M.) kansasii infection is more common in HIV patients, and appears to increase the risk of hospitalization. M. kansasii is a bacterium in the family of organisms that causes tuberculosis. Researchers studied 270 patients with M. kansasii infection, of whom 69% were also HIV-positive. Infected patients were generally of lower socioeconomic status, and 36% did not have stable housing. Ten percent of HIV-positive, mycobacterium-infected patients had a blood-borne infection, while no HIV-negative M. kansasii patients had bacteremia. Patients with M. kansasii infection were more likely to be hospitalized, and coinfected patients had more infectious organisms in their respiratory or other bodily fluids.

Health aspects, Complications and side effects, Demographic aspects, HIV infection, HIV infections, Mycobacterial infections, Mycobacterium infections

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