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Abstract:
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Invasive pneumococcal disease (IPD) is a leading cause of morbidity worldwide. Pneumococcal conjugate vaccine effectively reduces the number of IPD cases caused by vaccine-targeted serotypes among children who receive the vaccine and adults who are not directly vaccinated. Direct vaccination of adults might be warranted if geographic regions or subpopulations exist where targeted serotypes persist at higher levels than expected. We introduce a spatially varying change points probit regression model in the Bayesian setting, combined with spatially regression coefficients, to jointly determine if the beginning date of the vaccine-associated decline, the initial baseline proportion of IPD cases caused by vaccine-targeted serotypes, and/or the rate of decline of vaccine-targeted serotypes vary in the adult population across Connecticut, 1998-2009. Results indicate that there is significant spatial variability in the pattern with which vaccine-targeted serotypes decline, suggesting that the effect of directly vaccinating adults will differ over time and space. The newly developed model is shown to outperform a number of competitors in terms of explanatory and predictive ability.
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