The Challenge of Reducing Invasive Pneumococcal Disease in Indigenous Indian Populations
Bibliographic record
Abstract
Wherever it has been introduced into routine infant vaccination programs, the 7-valent pneumococcal conjugate vaccine (PCV7) has rapidly and very effectively reduced vaccine serotype (VT) invasive pneumococcal infections and related disease both in vaccine recipients and in unvaccinated children and adults through indirect protection. In some jurisdictions, VT invasive infections have been nearly eradicated, as has antecedent nasopharyngeal colonization with VTs. In turn, the large decrease in VT infections has been offset, to varying extent, by increased infections caused by a limited number of nonvaccine serotypes (NVTs)—particularly serotype 19A, which is often resistant to multiple antibiotics. Overall nasopharyngeal colonization rates have not changed, because the decrease in VT colonization has been completely offset by increases in colonization with NVTs. The effectiveness of PCV7 in indigenous populations compared with nonindigenous populations in the United States and Australia has been particularly remarkable, given the much higher rates of invasive pneumococcal infections in these populations before PCV7 introduction, compared with nonindigenous children. In Alaska, the incidence of invasive pneumococcal infections was 3 times higher among Alaska Native children aged <2 years than among non-Alaska Native children aged <2 years before the introduction of PCV7 (403 vs 135 cases per 100,000 population per year from 1995 to 2000) [1]. From 2004 to 2006, after the introduction of PCV7, the incidence of VT invasive pneumococcal infections decreased to similar levels in both groups (10 vs 2 cases per 100,000 population per year, respectively). For all ages combined, the incidence of VT invasive pneumococcal infection decreased by 90% over the same time period. As for NVT invasive pneumococcal infection, the incidence in Native Alaskans did not initially change after the introduction of PCV7. However, by 2004–2006 (4–6 years after PCV7 introduction), NVT invasive infections increased by 130% among Alaska Native children aged <2 years, and serotype 19A was the most common NVT. The overall rate of invasive pneumococcal infection in this group increased to 245 cases per 100,000 population per year, which was still 39% less than before PCV7 was introduced. In contrast, among non-Alaska Native children, the incidence of NVT invasive pneumococcal infections did not increase throughout the study period, and the overall decrease in invasive pneumococcal infection by 2004–2006 among children aged <2 years was 68%.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.008 | 0.008 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".