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IID-4.3 Data Details

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IID-4.3 Reduce invasive antibiotic-resistant pneumococcal infections among children under age 5 years

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

Data Source: 
Active Bacterial Core Surveillance (ABCS); Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (CDC/NCIRD)
Bridged-race Population Estimates; Centers for Disease Control and Prevention, National Center for Health Statistics and U.S. Census Bureau (CDC/NCHS and Census)
Changed Since the Healthy People 2020 Launch: 
Yes
Measure: 
per 100,000
Baseline (Year): 
8.3 (2008)
Target: 
6.0
Target-Setting Method: 
Projection/trend analysis
Target-Setting Method Justification: 
Whenever possible, assumptions used in the analysis were based on published data. The effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13, licensed in February 2010) was assumed to be similar to that of the 7-valent pneumococcal conjugate vaccine (PCV7, licensed in 2000). Also, invasive pneumococcal infections caused by strains not covered by PCV13 were assumed to increase modestly. Estimates were adjusted to account for the lower proportion of pneumococcal infections caused by PCV13 strains, compared with the proportion covered by PCV7 before that vaccine was introduced. Where published data were not available, assumptions were based on data available from CDC (www.cdc.gov/ABCs).
Numerator: 

Number of children under age 5 years with a laboratory-confirmed invasive antibiotic-resistant pneumococcal infection in the past 12 months

Denominator: 

Number of children under age 5 years

Comparable Healthy People 2010 Objective: 
Adapted from HP2010 objective
Data Collection Frequency: 
Annual
Methodology Notes: 

    A laboratory-confirmed invasive antibiotic-resistant pneumococcal infection is defined as the isolation of Streptococcus pneumoniae, from a normally sterile site (blood, cerebral spinal fluid, etc.), that is not susceptible to penicillin, amoxicillin, erythromycin, cefotaxime, ceftriaxone, cefuroxime, tetracycline, vancomycin, or levofloxacin according to the 2012 breakpoints defined by the Clinical and Laboratory Standards Institute.

    FOR SINGLE DATA YEARS: Case rates are calculated based on the resident population of the ABCs surveillance areas for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2010 –July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Postcensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories. Missing race data was multiply imputed and surveillance rates were standardized to the racial distribution of the US population using the NCHS bridged-race vintage 2010 postcensal file.

Caveats and Limitations: 
Cases with missing race data were multiply imputed using sequential regression imputation methods. ABCs Areas California (San Francisco County and children < 5 years in Alameda and Contra Costa counties); Colorado (5 county Denver area); Connecticut; Georgia (20 county Atlanta area); Maryland (6 county Baltimore area); Minnesota; New Mexico; New York (15 county Rochester and Albany areas and children <5 years in Erie county); Oregon (3 county Portland area); Tennessee (20 counties) ABCs Population The surveillance areas represent 29,757,552 persons. Source: National Center for Health Statistics bridged-race vintage 2010 postcensal file
Changes Between HP2010 and HP2020: 
This objective differs from Healthy People 2010 objective 14-05c in that the objective was revised from "penicillin-resistant pneumococcal infection" to "antibiotic-resistant pneumococcal infection."

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch: 
In 2013, the objective statement was changed from "Reduce invasive penicillin-resistant pneumococcal infections among children under age 5 years" to "Reduce invasive antibiotic-resistant pneumococcal infections among children under age 5 years." Doctors use many drugs to treat pneumococcal infections. Although penicillin still works well, it is not used often because other drugs can be taken once a day instead of four times a day. To make the Healthy People 2020 measure more useful to doctors and patients, the objective was revised to include infections resistant to several antibiotics, not just penicillin. The numerator definition was revised accordingly. The original baseline was revised from 4.3 to 8.2 cases per 100,000. The target was revised from 3.0 to 6.0 cases per 100,000 to reflect the revised baseline using the original target-setting method. In 2014, Population Estimates was added as a data source to reflect measure's population denominator. The data and target were not revised. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged.

References

Additional resources about the objective

  1. Centers for Disease Control and Prevention (CDC). Active Bacterial Core surveillance (ABCs).