Disappearance of vaccine-type invasive pneumococcal disease and emergence of serotype 19A in a minority population with a high prevalence of human immunodeficiency virus and low childhood immunization rates.

We analyzed the epidemiology of invasive pneumococcal disease (IPD) following introduction of pneumococcal conjugated vaccine in an urban population with a 2% human immunodeficiency virus (HIV) prevalence and history of low childhood immunization rates. We observed near-elimination of vaccine-type IPD. Substantial disease remains due to non-vaccine-type pneumococci, highlighting the need to increase pneumococcal immunization among HIV-infected adults.

Invasive pneumococcal disease in an underimmunized, high HIV prevalence population.

OBJECTIVE: To describe the epidemiology of invasive pneumococcal disease (IPD) in a predominantly minority population with low childhood immunization rates and high HIV prevalence, during the early childhood pneumococcal vaccine (PCV7) era. METHODS: A retrospective cases series analysis of 131 patients diagnosed with IPD at University Hospital in Newark, NJ from 2000 through 2005, and who had their pneumococcal isolates serotyped, was conducted. Changes in IPD over time were analyzed with the Cochran-Armitage test and linear regression. Multivariate logistic regression was conducted to determine risk factors for non-vaccine type IPD. RESULTS: Ninety-two percent of cases occurred in older children (>or=5 years) and adults, with 53.4% occurring in the 34-49 year-old age group. 90% of cases were black and 48% were HIV-infected. Among cases five years or older, there was a significant decrease in the proportion of IPD caused by vaccine serotypes (2000: 45.5%, 2001: 50.0%, 2002: 31.8%, 2003: 30.0%, 2004: 0.0%, 2005: 0.0%; p<0.0005). Concomitantly, PCV7 immunization rates among Newark infants increased (2002: 30.5%, 2003: 58.1%, 2004: 70.9%, 2005: 75.6%). Risk factors for non-vaccine type IPD included year of diagnosis and older male. CONCLUSION: At-risk populations, with high HIV prevalence and relatively low infant PCV7 immunization rates, may still be benefiting from PCV7-related herd protection effects.

Elevated blood lead concentrations and vitamin D deficiency in winter and summer in young urban children.

BACKGROUND: It is widely recognized that blood lead concentrations are higher in the summer than in winter. Although the effects of some environmental factors such as lead in dust on this phenomenon have been studied, relationships to sunlight-induced vitamin D synthesis have not been adequately investigated. Vitamin D status is influenced by the diet, sunlight exposure, age, skin pigmentation, and other factors, and may modify gastrointestinal lead absorption or release of lead stored in bones into the bloodstream. OBJECTIVE AND METHODS: We collected paired blood samples from 142 young, urban African-American and Hispanic children in the winter and summer to study the seasonal increase in blood lead and its relationships to vitamin D nutrition, age, and race. RESULTS: A winter/summer (W/S) increase in blood lead concentrations of 32.4% was found for children 1-3 years of age. There was a smaller W/S increase of 13.0% in children 4-8 years of age. None of the 51 Hispanic children had an elevated blood lead concentration (> or = 10 microg/dL) during the winter, and only one had an elevated summertime concentration. In contrast, elevated blood lead concentrations were frequent in the 91 African-American children, especially those 1-3 years of age. For the latter, the percentage with elevated blood lead levels increased from 12.2% in winter to 22.5% in summer. A 1.2% W/S increase in serum 25-hydroxy-vitamin D (serum 25-OH-D) concentrations was found for children 1-3 years of age. However, in children 4-8 years of age the W/S increase in serum 25-OH-D was much larger-33.6%. The percentages of children with low (< 16 microg/L) serum 25-OH-D concentrations were 12.0% in winter and 0.7% in summer and were consistently greater in African-American than in Hispanic children. The seasonal increases in blood lead and serum 25-OH-D in children 4-8 years of age were significantly associated. CONCLUSION: The higher summertime serum 25-OH-D concentrations for the 4- to 8-year-old children are likely caused by increased sunlight-induced vitamin D synthesis and may contribute to the seasonal increase in blood lead. Age and race are key factors that affect blood lead and vitamin D nutrition, as well as their interactions, in young urban children.

Muscle infarction in a 13 year-old female with type 1 diabetes mellitus of short duration.

A 13 year-old female with an 11-month history of type 1 diabetes mellitus (DM) was admitted to the hospital with a muscle infarction. Diagnosis of this rare complication of DM was suggested by clinical presentation, magnetic resonance imaging (MRI) and muscle biopsy. While diabetic muscle infarction (DMI) has been previously described in adult patients with long-standing DM associated with microangiopathy, it is an unexpected finding in this clinical setting.