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


Autoři: Shinthuja Wijayasri aff001;  Kelty Hillier aff001;  Gillian H. Lim aff001;  Tara M. Harris aff001;  Sarah E. Wilson aff001;  Shelley L. Deeks aff001
Působiště autorů: Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario, Canada aff001;  Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada aff002
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226353

Souhrn

Background

Ontario, Canada introduced a publicly-funded 13-valent pneumococcal conjugate vaccine (PCV13) for infants in 2010, replacing the 10-valent (PCV10, 2009–2010) and the 7-valent (PCV7, 2005–2009) conjugate vaccine programs; a 23-valent pneumococcal polysaccharide vaccine (PPV23) has been available for older adults since 1996. We examined the epidemiology and serotype distribution of invasive pneumococcal disease (IPD) in Ontario in the context of provincial immunization programs.

Methods

We included confirmed IPD cases reported in Ontario between 2007 and 2017. We grouped serotypes according to Ontario’s current immunization program (PCV13, PPV23, and non-vaccine-preventable) and calculated incidence rates (per 100,000 population) using population data.

Results

Between 2007 and 2017, annual incidence of IPD in Ontario ranged between 7.3 and 9.7/100,000 per year. Measures of illness severity were high throughout the period of surveillance. After PCV13 program implementation in 2010, incidence due to PCV13 serotypes decreased significantly across all age groups, with the greatest reductions in children <5 years and adults ≥65 years. Conversely, incidence due to PPV23 unique serotypes increased significantly between 2007 and 2017, with the greatest increases observed in adults 50–64 years (1.4 to 3.5/100,000) and ≥65 years (2.3 to 7.2/100,000). Similar increases were observed in incidence due to non-vaccine-preventable serotypes among all age groups, except infants <1 year. Within specific serotypes, incidence due to serotypes 3 (0.42 to 0.98/100,000) and 22F (0.31 to 0.72/100,000) increased significantly between 2007 and 2017, while incidence due to serotypes 19A and 7F decreased significantly during the PCV13 period (2010–2017).

Conclusions

Eight years after PCV13 implementation in Ontario, our data suggest both direct and indirect effects on serotype-specific incidence in young children and older adults. However, overall provincial rates have remained unchanged, and IPD continues to be a severe burden on the population. The rising incidence of IPD due to PPV23 unique and non-vaccine-preventable serotypes, and the growing burden of serotypes 3 and 22F, require further study.

Klíčová slova:

Age groups – Canada – Conjugate vaccines – Elderly – Infants – Ontario – Vaccination and immunization – Vaccines


Zdroje

1. Deng X, Church D, Vanderkooi OG, Low DE, Pillai DR. Streptococcus pneumoniae infection: A Canadian perspective. Expert Rev Anti Infect Ther. 2013;11(8): 781–791. doi: 10.1586/14787210.2013.814831 23977934

2. Drijkoningen JJC, Rohde GGU. Pneumococcal infection in adults: Burden of disease. Clin Microbiol Infect. 2014;20(S5): 45–51. doi: 10.1111/1469-0691.12461 24313448

3. Geno KA, Gilbert GL, Song JY, Skovsted IC, Klugman KP, Jones C, et al. Pneumococcal capsules and their types: Past, present, and future. Clin Microbiol Rev. 2015;28(3): 871–99. doi: 10.1128/CMR.00024-15 26085553

4. Bettinger JA, Scheifele DW, Kellner JD, Halperin SA, Vaudry W, Law B, et al. The effect of routine vaccination on invasive pneumococcal infections in Canadian children, Immunization Monitoring Program, Active 2000–2007. Vaccine. 2010;28(9): 2130–2136. doi: 10.1016/j.vaccine.2009.12.026 20044050

5. Demczuk WHB, Martin I, Griffith A, Lefebvre B, McGeer A, Lovgren M, et al. Serotype distribution of invasive Streptococcus pneumoniae in Canada after the introduction of the 13-valent pneumococcal conjugate vaccine, 2010–2012. Can J Microbiol. 2013;59(12): 778–788. doi: 10.1139/cjm-2013-0614 24313450

6. Public Health Agency of Canada. Vaccine Preventable Disease: Surveillance report to December 31, 2015 [Internet]. Ottawa, ON: Government of Canada; 2017 [cited 25 Feb 2019]. Available from: https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/healthy-living/vaccine-preventable-disease-surveillance-report-december-31-2015/vaccine-preventable-disease-eng.pdf

7. Ontario Agency for Health Protection and Promotion (Public Health Ontario). Factors affecting reportable diseases in Ontario (1991–2016) [Internet]. Toronto, ON: Queen’s Printer for Ontario; 2018 [cited 15 Mar 2019]. Available from: https://www.publichealthontario.ca/en/eRepository/Factors-reportable-diseases-Ontario-1991-2016.pdf

8. Rudnick W, Liu Z, Shigayeva A, Low DE, Green K, Plevneshi A, et al. Pneumococcal vaccination programs and the burden of invasive pneumococcal disease in Ontario, Canada, 1995–2011. Vaccine. 2013;31(49): 5863–71. doi: 10.1016/j.vaccine.2013.09.049 24099873

9. Lim GH, Wormsbecker AE, McGeer A, Pillai DR, Gubbay JB, Rudnick W, et al. Have changing pneumococcal vaccination programmes impacted disease in Ontario? Vaccine. 2013;31(24): 2680–85. doi: 10.1016/j.vaccine.2013.04.007 23597716

10. Government of Ontario. Health Protection and Promotion Act, R.S.O. 1990, c. H.7 [Internet]. 2018 [cited 25 Feb 2019]. Available from: https://www.ontario.ca/laws/statute/90h07

11. Ontario Ministry of Health and Long-Term Care. Infectious Disease Protocol: Appendix B: Provincial case definitions for reportable diseases: Disease: Pneumococcal disease, invasive [Internet]. 2014 [cited 30 Jan 2019]. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/pneumococcal_cd.pdf

12. Toronto Invasive Bacterial Diseases Network. Methodology: Surveillance Population [Internet]. 2019 [cited 12 Mar 2019]. Available from: http://www.tibdn.ca/methodology/surveillance-population

13. Shigayeva A, Rudnick W, Green K, Tyrrell G, Demczuk WHB, Gold WL, et al. Association of serotype with respiratory presentations of pneumococcal infection, Ontario, Canada, 2003–2011. Vaccine. 2016;34(6): 846–853. doi: 10.1016/j.vaccine.2015.11.021 26602266

14. Desai S, Policarpio ME, Wong K, Gubbay J, Fediurek J, Deeks S. The epidemiology of invasive pneumococcal disease in older adults from 2007 to 2014 in Ontario, Canada: a population-based study. CMAJ Open. 2016;4(3): E545–E550. doi: 10.9778/cmajo.20160035 27730119

15. Public Health Agency of Canada. Canadian Immunization Guide: Part 4—Active Vaccines: Pneumococcal Vaccine [Internet]. 2016 [cited 15 Feb 2019]. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-16-pneumococcal-vaccine.html

16. Statistics Canada. Population estimates (2007–2016) and projections (2017) [data file]. Ottawa, ON: Government of Canada [producer], Toronto, ON: Ministry of Health and Long-Term Care, intelliHEALTH Ontario [distributor]; data extracted 19 Oct 2017 (estimates) and 24 Oct 2017 (projections).

17. Dalcin D, Sieswerda L, Dubois S, Ulanova M. Epidemiology of invasive pneumococcal disease in indigenous and non-indigenous adults in northwestern Ontario, Canada, 2006–2015. BMC Infect Dis. 2018;18(1): 621. doi: 10.1186/s12879-018-3531-9 30514226

18. Eton V, Schroeter A, Kelly L, Kirlew M, Tsang RSW, Ulanova M. Epidemiology of invasive pneumococcal and Haemophilus influenzae diseases in Northwestern Ontario, Canada, 2010–2015. Int J Infect Dis. 2017;65: 27–33. doi: 10.1016/j.ijid.2017.09.016 28951105

19. Bruce MG, Singleton R, Bulkow L, Rudolph K, Zulz T, Gounder P, et al. Impact of the 13-valent pneumococcal conjugate vaccine (pcv13) on invasive pneumococcal disease and carriage in Alaska. Vaccine. 2015;33(38): 4813–4819. doi: 10.1016/j.vaccine.2015.07.080 26247901

20. Moore MR, Link-Gelles R, Schaffner W, Lynfield R, Lexau C, Bennett NM, et al. Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: Analysis of multisite, population-based surveillance. Lancet Infect Dis. 2015;15(3): 301–309. doi: 10.1016/S1473-3099(14)71081-3 25656600

21. Dagan R, Patterson S, Juergens C, Greenberg D, Givon-Lavi N, Porat N, et al. Comparative immunogenicity and efficacy of 13-valent and 7-valent pneumococcal conjugate vaccines in reducing nasopharyngeal colonization: A randomized double-blind trial. Clin Infect Dis. 2013;57(7): 952–962. doi: 10.1093/cid/cit428 23804191

22. Loughlin AM, Hsu K, Silverio AL, Marchant CD, Pelton SI. Direct and indirect effects of PCV13 on nasopharyngeal carriage of PCV13 unique pneumococcal serotypes in Massachusetts’ children. Pediatr Infect Dis J. 2014;33(5): 504–510. doi: 10.1097/INF.0000000000000279 24670957

23. Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils in Ontario: 2013–14, 2014–15 and 2015–16 school years [Internet]. Toronto, ON: Queen’s Printer for Ontario; 2017 [cited 28 Sep 2019]. Available from: https://www.publichealthontario.ca/-/media/documents/immunization-coverage-2013-16.pdf?la=en

24. Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils in Ontario: 2016–17 school year [Internet]. Toronto, ON: Queen’s Printer for Ontario; 2018 [cited 14 Mar 2019]. Available from: https://www.publichealthontario.ca/-/media/documents/immunization-coverage-2016-17.pdf?la=en

25. Public Health Agency of Canada. Vaccine Coverage in Canadian Children: results from the 2013 childhood National Immunization Coverage Survey (CNICS) [Internet]. Ottawa, ON: Government of Canada; 2017 [cited 20 Oct 2019]. Available from: http://publications.gc.ca/collections/collection_2017/aspc-phac/HP40-156-2017-eng.pdf

26. Ho PL, Law PYT, Chiu SS. Increase in incidence of invasive pneumococcal disease caused by serotype 3 in children eight years after the introduction of the pneumococcal conjugate vaccine in Hong Kong. Hum Vaccines Immunother. 2018;15(2): 455–58. doi: 10.1080/21645515.2018.1526555 30261157

27. Horácio AN, Silva-Costa C, Lopes JP, Ramirez M, Melo-Cristino J, Vaz T, et al. Serotype 3 remains the leading cause of invasive pneumococcal disease in adults in portugal (2012–2014) despite continued reductions in other 13-valent conjugate vaccine serotypes. Front Microbiol. 2016;7(OCT): 1616. doi: 10.3389/fmicb.2016.01616 27790208

28. Càmara J, Marimón JM, Cercenado E, Larrosa N, Quesada MD, Fontanals D, et al. Decrease of invasive pneumococcal disease (IPD) in adults after introduction of pneumococcal 13-valent conjugate vaccine in Spain. PLoS One. 2017;12(4): e0175224. doi: 10.1371/journal.pone.0175224 28384325

29. Lapidot R, Shea KM, Little BA, Yildirim I, Pelton SI. Impact of PCV13 on Serotype 3 Invasive Pneumococcal Disease and Nasopharyngeal Carriage in Massachusetts’ Children. Open Forum Infect Dis. 2017;4(Suppl 1): S467.

30. Southern J, Andrews N, Sandu P, Sheppard CL, Waight PA, Fry NK, et al. Pneumococcal carriage in children and their household contacts six years after introduction of the 13-valent pneumococcal conjugate vaccine in England. PLoS One. 2018;13(5): e0195799. doi: 10.1371/journal.pone.0195799 29799839

31. Public Health Agency of Canada. Vaccine uptake in Canadian adults: results from the 2016 adult National Immunization Coverage Survey (aNICS) [Internet]. Government of Canada. Ottawa, ON: Government of Canada; 2016 [cited 7 Mar 2019]. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/vaccine-uptake-canadian-adults-results-2014-adult-national-immunization-coverage-survey.html

32. Djennad A, Ramsay ME, Pebody R, Fry NK, Sheppard C, Ladhani SN, et al. Effectiveness of 23-Valent Polysaccharide Pneumococcal Vaccine and Changes in Invasive Pneumococcal Disease Incidence from 2000 to 2017 in Those Aged 65 and Over in England and Wales. EClinicalMedicine. 2018;6: 42–50. doi: 10.1016/j.eclinm.2018.12.007 31193709

33. Suzuki M, Dhoubhadel BG, Ishifuji T, Yasunami M, Yaegashi M, Asoh N, et al. Serotype-specific effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumococcal pneumonia in adults aged 65 years or older: a multicentre, prospective, test-negative design study. Lancet Infect Dis. 2017;17(3): 313–321. doi: 10.1016/S1473-3099(17)30049-X 28126327

34. Mahmud SM, Sinnock H, Mostaço-Guidolin LC, Pabla G, Wierzbowski AK, Bozat-Emre S. Long-term trends in invasive pneumococcal disease in Manitoba, Canada. Hum Vaccines Immunother. Taylor & Francis; 2017;13(8): 1884–91. doi: 10.1080/21645515.2017.1320006 28494193

35. Duvvuri VR, Deng X, Teatero S, Memari N, Athey T, Fittipaldi N, et al. Population structure and drug resistance patterns of emerging non-PCV-13 Streptococcus pneumoniae serotypes 22F, 15A, and 8 isolated from adults in Ontario, Canada. Infect Genet Evol. 2016;42: 1–8. doi: 10.1016/j.meegid.2016.04.007 27071529

36. Demczuk WHB, Martin I, Hoang L, Van Caeseele P, Lefebvre B, Horsman G, et al. Phylogenetic analysis of emergent Streptococcus pneumoniae serotype 22F causing invasive pneumococcal disease using whole genome sequencing. PLoS One. 2017;12(5): e0178040. doi: 10.1371/journal.pone.0178040 28531208

37. Golden AR, Adam HJ, Zhanel GG. Invasive Streptococcus pneumoniae in Canada, 2011–2014: Characterization of new candidate 15-valent pneumococcal conjugate vaccine serotypes 22F and 33F. Vaccine. 2016;34(23): 2527–2530. doi: 10.1016/j.vaccine.2016.03.058 27085174

38. Marrie TJ, Tyrrell GJ, Majumdar SR, Eurich DT. Effect of Age on the Manifestations and Outcomes of Invasive Pneumococcal Disease in Adults. Am J Med. 2017;131(1): 100.e1–100.e7. doi: 10.1016/j.amjmed.2017.06.039 28803139

39. Song JY, Choi JY, Lee JS, Bae IG, Kim YK, Sohn JW, et al. Clinical and economic burden of invasive pneumococcal disease in adults: A multicenter hospital-based study. BMC Infect Dis. 2013;13(1): 202. doi: 10.1186/1471-2334-13-202 23641904

40. Schuck-Paim C, Taylor RJ, Alonso WJ, Weinberger DM, Simonsen L. Effect of pneumococcal conjugate vaccine introduction on childhood pneumonia mortality in Brazil: a retrospective observational study. Lancet Glob Heal. 2019;7(2): e249–e256. 3068324

41. Von Mollendorf C, Tempia S, Von Gottberg A, Meiring S, Quan V, Feldman C, et al. Estimated severe pneumococcal disease cases and deaths before and after pneumococcal conjugate vaccine introduction in children younger than 5 years of age in South Africa. PLoS One. 2017;12(7): e0179905. doi: 10.1371/journal.pone.0179905 28671978

42. Navarro-Torné A, Dias JG, Hruba F, Lopalco PL, Pastore-Celentano L, Amato Gauci AJ, et al. Risk factors for death from invasive pneumococcal disease, Europe, 2010. Emerg Infect Dis. 2015;21(3): 417–425. doi: 10.3201/eid2103.140634 25693604

43. Lexau CA, Lynfield R, Danila R, Pilishvili T, Facklam R, Farley MM, et al. Changing epidemiology of invasive pneumococcal disease among older adults in the era of pediatric pneumococcal conjugate vaccine. J Am Med Assoc. 2005;294(16): 2043–2051. doi: 10.1001/jama.294.16.2043 16249418

44. Burgos J, Falcó V, Borrego A, Sordé R, Larrosa MN, Martinez X, et al. Impact of the emergence of non-vaccine pneumococcal serotypes on the clinical presentation and outcome of adults with invasive pneumococcal pneumonia. Clin Microbiol Infect. 2013;19(4): 385–391. doi: 10.1111/j.1469-0691.2012.03895.x 22583156


Článek vyšel v časopise

PLOS One


2019 Číslo 12