Editorial Commentary:Changing Epidemiology of Invasive Pneumococcal Disease: A Complicated Story

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Abstract
Streptococcus pneumoniae is a leading cause of pneumonia and meningitis worldwide, and >1 million children die because of pneumococcal infections globally each year [1]. Such infections are due to various pneumococcal serotypes, and the serotypes responsible for these infections vary with time and geography. Although children are generally at the highest risk for both pneumonia and invasive disease, in some populations in the world, this risk is much higher. Such populations include Native American Indians, Alaskan indigenous populations, and the Australian Aboriginals. In the White Mountain Apache (WMA) population, the risk of invasive pneumococcal disease was 8-fold higher prior to vaccine introduction, than it was in the general US population. Although the reasons for this elevated risk are still not completely understood, this elevated risk has resulted in extensive study of the WMA population. In this issue of Clinical Infectious Diseases, Lacapa et al. [2] report on the impact of the introduction of 7-valent pneumococcal conjugate vaccine into the WMA population in Arizona. This study is very beneficial to our understanding of the dynamics of pneumococcal epidemiology in general and of the impact, both positive and negative, that vaccine introduction may have in a population.

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