Persistent Sex Disparities in Invasive Pneumococcal Diseases in the Conjugate Vaccine Era

Abstract

Background. Few studies have characterized the role of sex on the incidence of invasive pneumococcal disease (IPD). We examined sex differences in rates of IPD, and trends after the introduction of pneumococcal conjugate vaccines (PCVs).Methods. We used active population and laboratory-based IPD surveillance data from the Centers for Disease Control and Prevention Active Bacterial Core surveillance program (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) in Tennessee. Population-based rates of IPD by sex, race, age group, and PCV era were calculated. Rates were compared using incidence rate ratios.Results. Throughout the study years, rates of IPD were higher in male than in female subjects, particularly in children <2 years and adults 40-64 years of age, with male subjects having IPD rates 1.5-2 times higher than female subjects. The proportions of comorbid conditions were similar in male and female subjects . Sex rate differences persisted after stratification by race. Although the introductions of 7-valent PCV (PCV7) and 13-valent PCV (PCV13) were associated with declines in IPD rates in both sexes, rates of IPD after PCV13 were still significantly higher in male than in female subjects among children and adults 40-64 and >74 years of age.Conclusions. Rates of IPD were generally higher in male than in female subjects. These sex differences were observed in different race groups and persisted after introduction of both PCVs.

Sex differences in common childhood infections in Taiwan

“…However, in this population with high healthcare access, large sex differences would not be expected, especially when giving specific diagnoses such as croup or acute bronchiolitis. The populationbased finding of a male tendency with regard to conjunctivitis and respiratory infections, enteritis, and urinary tract infections is largely consistent with case-only (Ladhani et al, 2013;de St Maurice et al, 2016;Koehoorn et al, 2008;Jensen-Fangel et al, 2004;Shaikh et al, 2008), hospital-based (Jensen-Fangel et al, 2004, or reported case-based (Boore et al, 2015;Reller et al, 2008) analyses in other countries. The greater sex difference in hand, foot, and mouth disease and the weak difference in herpangina in this analysis was also observed in a surveillancebased study in Japan (Eshima et al, 2012).…”

Gender disparity in pediatrics: a review of the current literature

“…In fact, estrogen receptors were found on T cells, B cells, dendritic cells, and macrophages. However, some gender-related behaviors, such as smoking, are important drivers of IPD risk, especially among adolescents and adults but this concern is not important among young children, among whom strong gender differences have been noted [ 36 ].…”

Multicenter study of pneumococcal carriage in children 2 to 4 years of age in the winter seasons of 2017-2019 in Irbid and Madaba governorates of Jordan

“…This result was the opposite in Irbid, where female carriage rate was 31.0% compared to male carriage rate 28.2%. Few studies have been done on sex disparities in pneumococcal carriage or in pneumococcal invasive diseases, these disparities are thought to be due to biological and behavioral differences, which also vary with age [30]. Factors that contribute to high carriage rates in both cities are: low income, family members that smoke, and a high number of children per household as an important risk factor [4,31].…”