Seroepidemiology of invasive pneumococcal disease in Queensland, 1990 to 1997.

Serotypes responsible for 842 cases of invasive pneumococcal disease in Queensland between February 1990 and October 1997 were identified. Type 14 caused 37.5% of episodes in children aged 0-4 years and 19.2% of adult cases. Types 6A, 6B, 14, 18C, and 19F were significantly more frequent in young children while types 3, 4, 7F, 9V and 23F predominated in adults. The regional incidence of type 14 and 7F disease differed significantly in Southeast and Far North Queensland. Coverage for 87% of children aged less than 5 years in this study would be provided by a recently advocated polysaccharide-protein conjugate vaccine containing capsular antigens of types 4, 6B, 9V, 14, 18C, 19F and 23F. Similarly, more than 90% of adults would be covered by the currently available 23- valent polysaccaride vaccine.

Pneumococcal vaccination: an important strategy to prevent pneumonia in Aboriginal and Torres Strait Island adults.

The objective of the study was to examine the appropriateness of the National Health and Medical Research Council (NHMRC) recommendations concerning pneumococcal vaccination for Aboriginal and Torres Strait Island adults. Laboratory surveillance of invasive pneumococcal disease identified 95 cases acquired by adults 15 years of age and over in Far North Queensland from 1992 to 1995. The most common diagnosis was pneumonia (77 per cent). Sixty-one cases (64 per cent) occurred in Aboriginal and Torres Strait Island adults, who acquired the disease at a younger age (mean 40 years) than did other adults (mean 50 years). Most (93 per cent) of the Aboriginal and Torres Strait Island adults had at least one of the pre-existing medical conditions in the NHMRC criteria for pneumococcal vaccination. The most common was 'alcohol abuse' (62 per cent). Fifty-three (93 per cent) of the pneumococcal isolates from the Aboriginal and Torres Strait Island adults who had pre-existing conditions were serotyped. Fifty (94 per cent) belonged to types included in the currently available pneumococcal vaccine. We conclude that the NHMRC recommendations for pneumococcal vaccination are appropriate, considering the pattern of invasive pneumococcal disease that occurs in Aboriginal and Torres Strait Island adults in Far North Queensland. Because pneumococcal vaccination can reduce the pneumonia-associated morbidity and premature mortality experienced by Aboriginal and Torres Strait Island adults, the vaccine should be offered routinely to those considered to be at risk, particularly young men who have recently begun to consume hazardous amounts of alcohol, and recently diagnosed diabetics.

The incidence of bacteraemia following laryngeal mask insertion.

The incidence of bacteraemia following insertion of the laryngeal mask airway (LMA) was investigated in one hundred fit patients. Four cultures were positive: three represented contamination with skin flora; the other was a microaerophilic streptococcus grown from an anaerobic culture bottle. Although this organism can be pathogenic, it may also represent contamination. Our findings suggest that significant bacteraemia on insertion of the LMA is uncommon and is probably no more than with oral intubation. Antibiotic prophylaxis is of doubtful benefit in these circumstances.