Outbreak of Invasive Streptococcus pneumoniae Serotype 12F Among a Marginalized Inner-City Population in Winnipeg, Canada, 2009-2011

Schillberg, Erin; Isaac, Michael; Deng, Xianding; Peirano, Gisele; Wylie, John; Caeseele, Paul Van; Pillai, Dylan R.; Sinnock, Hasantha; Mahmud, Salaheddin M.

doi:10.1093/cid/ciu366

Cited by 34 publications

(37 citation statements)

References 30 publications

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“…Agestandardized annual rates fluctuated over the study period, but overall, they were higher in recent years reaching a peak of 13.2 (8.3-18.0)/100,000 in 2010 when inner city parts of Winnipeg had a large outbreak of 12F serotype infections. 7 Children under 2 y had the highest incidence over the study period, at 37.6 (32.1-43.9), followed by adults 65 y and older at 15.9 (14.4-17.6)/100,000. Rates were much lower in other age groups and lowest among 5-17 year-olds at 2.2 (1.8-2.8)/ 100,000.…”

Section: Resultsmentioning

confidence: 88%

“…[3][4][5][6] In Manitoba, recent outbreaks of IPD among the urban homeless and other disadvantaged populations have raised concerns that long-term disease trends remain unfavourable. 7 However, IPD's burden of illness and long-term trends have not been examined, particularly among those with vaccine indications such as chronic diseases. 7,8 This information is essential for planning and evaluating vaccination programs and other disease control measures.…”

Section: Introductionmentioning

confidence: 99%

“…7 However, IPD's burden of illness and long-term trends have not been examined, particularly among those with vaccine indications such as chronic diseases. 7,8 This information is essential for planning and evaluating vaccination programs and other disease control measures.…”

Section: Introductionmentioning

confidence: 99%

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

Mahmud

Sinnock

Mostaço-Guidolin

et al. 2017

Human Vaccines & Immunotherapeutics

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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.

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Section: Resultsmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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

Mahmud

Sinnock

Mostaço-Guidolin

et al. 2017

Human Vaccines & Immunotherapeutics

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“…The Alaska outbreak lasted for 2 years, possibly due to a transmission scenario whereby a new 12F clone was introduced into a rural population, and was carried early by immunologically naive children who then transmitted the clone to adults [8]. In contrast, the Canadian outbreak, which also lasted for >2 years, occurred among adults who were expected to have acquired herd immunity, with approximately one-third having previously received the 7-valent conjugate pneumococcal vaccine or 23-valent polysaccharide vaccine that includes the 12F polysaccharide [15]. It is possible that this drug-resistant clone is more virulent than its ancestral drug-sensitive clone, while maintaining its high transmission capability.…”

Section: Discussionmentioning

confidence: 99%

“…Between 2008 and 2011, 36 cases of septicemia, meningitis, and pneumonia due to serotype 12F were reported, resulting in 19 hospitalizations and 3 deaths [15]. MLST indicated that all serotype 12F isolates belonged to ST218.…”

mentioning

confidence: 99%

Whole-Genome Sequencing Reveals the Origin and Rapid Evolution of an Emerging Outbreak Strain ofStreptococcus pneumoniae12F

et al. 2016

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Background. Streptococcus pneumoniae is a major cause of community-acquired pneumonia and septicemia in adults. The global drug-susceptible capsular serotype 12F, clonal complex 218 caused several outbreaks in the United States between 1989 and 2008, as well as a recent large outbreak in Manitoba, Canada, that resulted in 36 cases of septicemia and 3 deaths. The evolutionary origin of the Canadian outbreak strain and its relationship to the historical US outbreak strains are not known.Methods. Whole-genome deep sequencing was performed on isolates from the Canadian outbreak (n = 36), the US outbreaks (n = 9), and nonoutbreak surveys (n = 21). Phylogenomic analysis and comparative genomics were used to assess evolutionary relationships and to detect gene content differences between the isolates.Results. The Canadian outbreak was closely related to sporadic cases that occurred preoutbreak in cross-border geographic regions in Manitoba, North Dakota, and Iowa. The emerging Canadian strain differed from US strains by acquisition of a cell-surface protein and macrolide resistance determinants via incorporation of a 5.3-kb mega cassette harboring msrD and mefE. Furthermore, during 11 months of transmission, this clone evolved rapidly and acquired fluoroquinolone resistance through precise stepwise mutations in both parC and gyrA, and putative compensatory mutations in uraA or IMPDH under drug selection. Alarmingly, this drug-resistant clone appears to have spread quickly to other regions of Canada and the United States, and replaced drug-susceptible strains.Conclusions. Whole-genome sequencing revealed an independent emergence and secondary adaptation of a new virulent and drug-resistant pneumococcal epidemic clone. Ongoing molecular surveillance is required, and measures to prevent its spread should be developed.

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