Long-term trends in invasive pneumococcal disease in Manitoba, Canada

Abstract

Invasive pneumococcal disease (IPD) remains a significant public health problem in Manitoba, Canada although publically-funded pneumococcal conjugate (PCV7 and PCV13) and polysaccharide (PPV23) vaccination programs exist. We analyzed routine surveillance and administrative health data to examine trends in IPD rates as these vaccines were introduced. Data on all individuals with a laboratory-confirmed diagnosis of IPD between 2001 and 2014 were obtained from the provincial Communicable Diseases Surveillance database and linked with Manitoba's provincial immunization registry and physician and hospital databases. We calculated IPD incidence rates overall, by serotype and for different population subgroups defined by socio-demographic and clinical (e.g., chronic diseases, immune status) characteristics. Annual IPD incidence (95%CI) was 8.6 (8.2-9.1)/100,000 people during the study period (n = 1092), and rates were higher in recent years and in regions with predominately indigenous populations. Reduction in the incidence of serotypes included in PCV7 have been offset by rising rates of PCV13-only serotypes in children, and more recently by rising rates of PPV-only serotypes and non-vaccine serotypes among young children and older adults (≥ 65 years). Rates were 3 times higher in those with a chronic disease and highest (> 175-fold) among alcoholics, organ-transplant, and chronic kidney failure patients. The case fatality rate was 12.0% within 30 d of diagnosis. Despite the introduction of several vaccination programs, overall rates of IPD have not declined in Manitoba in the last decade, due to increase in incidence of non-PCV7 serotypes. A disproportionately high burden of disease impacts indigenous communities and people with chronic disease.

An Observational Prospective Cohort Study of Incidence and Outcome of Streptococcus pneumoniae and Hemophilus influenzae Infections in Adult Solid Organ Transplant Recipients

“…In a recent meta-analysis, the pooled IR of invasive S. pneumoniae infections in SOT recipients was 465 per 100,000 PYFU [ 11 ] which is about six times higher than our estimates. These studies also included patients from before 2007 when vaccination against S. pneumoniae was not yet included in the universal childhood vaccination programs which may explain the discrepancy [ 11 , 12 ]. The 7-valent pneumococcal conjugated vaccine was introduced in Europe in 2001 and in the Danish Childhood Vaccination Program in 2007 [ 13 , 14 ].…”

“…In a cohort study that was done between 2001 and 2014, the IR of IPD was 414 per 100,000 PYFU [ 11 ]. In a recent meta-analysis, the pooled IR of invasive S. pneumoniae infections in SOT recipients was 465 per 100,000 PYFU [ 11 ] which is about six times higher than our estimates.…”

“…In a cohort study that was done between 2001 and 2014, the IR of IPD was 414 per 100,000 PYFU [ 11 ]. In a recent meta-analysis, the pooled IR of invasive S. pneumoniae infections in SOT recipients was 465 per 100,000 PYFU [ 11 ] which is about six times higher than our estimates. These studies also included patients from before 2007 when vaccination against S. pneumoniae was not yet included in the universal childhood vaccination programs which may explain the discrepancy [ 11 , 12 ].…”

The shifting epidemiology and serotype distribution of invasive pneumococcal disease in Ontario, Canada, 2007-2017

“…While Ontario-specific coverage estimates for adults are not available, the Public Health Agency of Canada has estimated that coverage for the PPV23 vaccine among Canadian adults 65 years and older was 41.6% in 2016, well below the national target of 80% [31]. Studies have also observed low effectiveness or only short-term protection of PPV23 against IPD in older adults [32–34]. The growing burden of serotype 22F (covered by PPV23 but not PCV13) that we observed has also been observed in other studies in Ontario and nationally [17,18,35,36].…”

The coverage of influenza and pneumococcal vaccination among kidney transplant recipients and waiting list patients: A cross‐sectional survey in Denmark

“…Patients with chronic kidney disease (CKD), listed for kidney transplantation and kidney transplant recipients (KTR), have an increased risk of infections such as invasive pneumococcal disease. 1 Among measures to prevent this, immunization against preventable infections such as influenza and pneumococcal disease is important, as CKD patients and KTR have an increased morbidity and mortality owing to these diseases compared to the background population. [2][3][4][5][6] Seasonal influenza vaccination and pneumococcal vaccinations are therefore recommended for CKD patients including kidney transplant waiting list patients (WLP) and KTR.…”