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Canadian Journal of Public Health

, Volume 99, Issue 1, pp 57–61 | Cite as

Epidemiology of Invasive Pneumococcal Disease in BC during the Introduction of Conjugated Pneumococcal Vaccine

  • Meghan Winters
  • David M. Patrick
  • Fawziah Marra
  • Jane Buxton
  • Mei Chong
  • Judith L. Isaac-Renton
  • Carol Shaw
  • Gregory J. Tyrrell
  • Marguerite Lovgren
  • Stephane Paulus
Article

Abstract

Objectives

Antimicrobial resistance in Streptococcus pneumoniae has increased in recent decades. We linked two surveillance programs to evaluate trends in incidence, serotype distribution, and antimicrobial resistance in invasive pneumococcal disease (IPD) since the heptavalent pneumococcal conjugate vaccine (PCV7) was introduced in BC in 2003.

Methods

IPD case reports for BC from 2002–2005 from the BC Centre for Disease Control were linked to serotype and antimicrobial susceptibility results from the National Centre for Streptococcus (NCS).

Results

There was a significant decrease in IPD incidence in children <5 from 54/100,000 in 2002 to 16/100,000 population in 2005 (70% decrease, p<0.001). The most dramatic decline was in children aged 1 year, where the rate fell from 135/100,000 to 15/100,000 (89% decrease, p for trend <0.001). Overall, 728/1288 (56.5%) reported cases of IPD were referred to NCS. For all matched cases, the proportion of isolates of PCV7 preventable serotypes decreased from 68.9% to 43.8% (p for trend <0.001) between 2002 and 2005. In children <2 years, this proportion decreased from 83.0% (39/47 cases) to 16.7% (1/6 cases) (p=0.006). The prevalence of non-susceptible isolates was highest for trimethoprim-sulfamethoxazole (15.3%, 111/725 tested), penicillin (9.1%, 66/728), and erythromycin (9.1%, 66/727). 10.3% (75/728) were non-susceptible to ≥2 classes of antimicrobials. Children <15 years of age had the highest proportion of non-susceptible isolates.

Discussion

The incidence of IPD in children has decreased significantly since the introduction of PCV7. Comprehensive serotype and antimicrobial susceptibility can aid in evaluating the impact of immunization programs.

Keywords

Pneumococcal infections antimicrobial drug resistance pneumococcal vaccines Canada 

Résumé

Objectifs

Depuis quelques décennies, la résistance aux antimicrobiens contre Streptococcus pneumoniae est en hausse. Nous avons relié deux programmes de surveillance afin d’évaluer les tendances relatives à l’incidence, à la distribution des sérotypes et à la résistance aux antimicrobiens pour les maladies invasives à pneumocoques (MIP) depuis l’introduction du vaccin antipneumococcique conjugué heptavalent (VCP7) en Colombie-Britannique en 2003.

Méthode

Les cas de MIP déclarés en Colombie-Britannique de 2002 à 2005, obtenus du BC Centre for Disease Control, ont été liés aux résultats par sérotype et par sensibilité aux antimicrobiens du Centre national pour le streptocoque (CNS).

Résultats

Nous avons observé une diminution significative de l’incidence des MIP chez les enfants de moins de 5 ans, qui est passée de 54 p. 100 000 en 2002 à 16 p. 100 000 en 2005 (soit une baisse de 70 %, p<0,001). La chute la plus spectaculaire a été observée chez les enfants d’1 an, chez qui les taux sont passés de 135 p. 100 000 à 15 p. 100 000 (soit une baisse de 89 %, p<0,001). Globalement, 728 des 1 288 cas déclarés de MIP (56,5 %) ont été dirigés vers le CNS. Pour tous les cas assortis, la proportion des isolats de sérotypes évitables par le VCP7 a diminué, passant de 68,9 % à 43,8 % (p<0,001) entre 2002 et 2005. Chez les enfants de moins de 2 ans, cette proportion est passée de 83 % (39 cas sur 47) à 16,7 % (1 cas sur 6) (p=0,006). La prévalence des isolats résistants était la plus élevée pour le triméthoprime-sulfaméthoxazole (15,3 %, 111/725), la pénicilline (9,1 %, 66/728) et l’érythromycine (9,1 %, 66/727). Une proportion de 10,3 % (75/728) des isolats étaient résistants à 2 classes ou plus d’antimicrobiens. Les enfants de moins de 15 ans avaient la proportion la plus élevée d’isolats résistants.

Discussion

L’incidence des MIP chez les enfants a diminué de façon significative depuis l’introduction du VCP7. L’inclusion de tous les sérotypes et la sensibilité aux antimicrobiens sont deux éléments qui peuvent faciliter l’évaluation des impacts des programmes d’immunisation.

Motsclés

infections à pneumocoques résistance aux antimicrobiens vaccins antipneumococciques Canada 

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References

  1. 1.
    WHO. Overcoming antimicrobial resistance. World Health Organization, 2000. Available online at: https://doi.org/www.who.int/infectious-disease-report/2000/index.html (Accessed October 20, 2005).Google Scholar
  2. 2.
    Cizman M. The use and resistance to antibiotics in the community. Int J Antimicrob Agents 2003;21:297–307.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Goossens H, Sprenger M. Community acquired infections and bacterial resistance. BMJ 1998;317:654–57.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Conly J. Antimicrobial resistance in Canada. CMAJ 2002;167:885–91.PubMedCentralPubMedGoogle Scholar
  5. 5.
    Powis J, McGeer A, Green K, Vanderkooi O, Weiss K, Zhanel G, et al. In vitro antimicrobial susceptibilities of streptococcus pneumoniae clinical isolates obtained in Canada in 2002. Antimicrob Agents Chemother 2004;48:3305–11.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Whitney CG, Farley MM, Hadler J, Harrison LH, Lexau C, Reingold A, et al. Increasing prevalence of multidrug-resistant Streptococcus pneu-moniae in the United States. N Engl J Med 2000;343:1917–24.CrossRefPubMedGoogle Scholar
  7. 7.
    National Advisory Committee on Immunization. Statement on recommended use of pneumococcal conjugate vaccine. CCDR 2002;28 (ACS-2).Google Scholar
  8. 8.
    Chen DK, McGeer A, de Azavedo JC, Low DE. Decreased susceptibility of Streptococcus pneu-moniae to fluoroquinolones in Canada. N Engl J Med 1999;341:233–39.CrossRefPubMedGoogle Scholar
  9. 9.
    Zhanel GG, Palatnick L, Nichol KA, Bellyou T, Low DE, Hoban DJ. Antimicrobial resistance in respiratory tract Streptococcus pneumoniae isolates: Results of the Canadian Respiratory Organism Susceptibility study, 1997 to 2002. AAC 2003;47:1867–74.CrossRefGoogle Scholar
  10. 10.
    Paulus S, David ST, Tang W, Winters M, Buxton J, Henry B, et al. Incidence of invasive pneumococcal disease after the introduction of the universal immunization programme in B.C. (2002–2005). CCDR 2006;32:157–61.Google Scholar
  11. 11.
    National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing. Fourteenth informational supplement. Document standard M100-14. In: National Committee for Clinical Laboratory Standards, Wayne, PA, 2004.Google Scholar
  12. 12.
    BC STATS, BC Ministry of Labour and Citizens Services and Health Data Warehouse. Population Extrapolation for Organizational Planning with Less Error (P.E.O.P.L.E.), 2005.Google Scholar
  13. 13.
    Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM, Lynfield R, et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 2003;348:1737–46.CrossRefGoogle Scholar
  14. 14.
    Stephens D, Zughaier S, Whitney C, Baughman WS, Barker L, Gay K, et al. Incidence of macrolide resistance in Streptococcus pneumoniae after introduction of the pneumococcal conjugate vaccine: Population-based assessment. Lancet 2005;365:855–63.CrossRefPubMedGoogle Scholar
  15. 15.
    Kyaw MH, Lynfield R, Schaffner W, Craig AS, Hadler J, Reingold A, et al. Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med 2006;354:1455–63.CrossRefPubMedGoogle Scholar
  16. 16.
    Centre for Disease Control. National Immunization Survey, 2005 data. Available online at: https://doi.org/www2a.cdc.gov/nip/coverage/nis/nis_iap.asp?fmt=v&rpt=tab09_24mo_iap&qtr=Q1/2005-Q4/2005 (Accessed March 15, 2007).Google Scholar
  17. 17.
    Centre for Disease Control. Early Release of Selected Estimates Based on Data From the January-March 2006 National Health Interview Survey. Available online at: https://doi.org/www.cdc.gov/nchs/data/nhis/earlyrelease/200609_05.pdf (Accessed March 15, 2007).
  18. 18.
    BC Centre for Disease Control. Performance measure 32: Two-year olds with up-to-date immunizations. 2005 cycle. Vancouver, BC, 2006.Google Scholar
  19. 19.
    Chen DK, McGeer A, de Azavedo JC, Low DE. Decreased susceptibility of Streptococcus pneu-moniae to fluoroquinolones in Canada. Canadian Bacterial Surveillance Network. N Engl J Med 1999;341:233–39.CrossRefPubMedGoogle Scholar
  20. 20.
    Canadian Bacterial Surveillance Network. Trends in Antimicrobial Resistance in Streptococcus pneumoniae - Canada. Available online at: https://doi.org/microbiology.mtsinai.on.ca/data/sp/sp_can.shtml (Accessed April 26, 2006).
  21. 21.
    Canadian Bacterial Surveillance Network. Trends in Antimicrobial Resistance in Streptococcus pneumoniae - British Columbia. Available online at: https://doi.org/microbiology.mtsinai.on.ca/data/sp/sp_bc.shtml (Accessed April 26, 2006).
  22. 22.
    Hausdorff WP, Feikin DR, Klugman KP. Epidemiological differences among pneumococ-cal serotypes. Lancet Infect Dis 2005;5:83–93.CrossRefPubMedGoogle Scholar
  23. 23.
    File TM, Jr. Streptococcus pneumoniae and community-acquired pneumonia: A cause for concern. Am J Med 2004;117(Suppl 3A):39S-50S.Google Scholar
  24. 24.
    Nuermberger E, Bishai WR. The clinical significance of macrolide-resistant Streptococcus pneu-moniae: It’s all relative. Clin Infect Dis 2004;38:99–103.CrossRefPubMedGoogle Scholar
  25. 25.
    Lynch IJ, Martinez FJ. Clinical relevance of macrolide-resistant Streptococcus pneumoniae for community-acquired pneumonia. Clin Infect Dis 2002;34(Suppl 1):S27-S46.Google Scholar
  26. 26.
    Peterson LR. Penicillins for treatment of pneu-mococcal pneumonia: Does in vitro resistance really matter? Clin Infect Dis 2006;42:224–33.CrossRefPubMedGoogle Scholar

Copyright information

© The Canadian Public Health Association 2008

Authors and Affiliations

  • Meghan Winters
    • 1
  • David M. Patrick
    • 1
    • 2
  • Fawziah Marra
    • 2
  • Jane Buxton
    • 1
    • 2
  • Mei Chong
    • 2
  • Judith L. Isaac-Renton
    • 2
    • 3
  • Carol Shaw
    • 2
  • Gregory J. Tyrrell
    • 4
  • Marguerite Lovgren
    • 4
  • Stephane Paulus
    • 5
  1. 1.Department of Health Care and EpidemiologyUniversity of British ColumbiaVancouverCanada
  2. 2.British Columbia B.C. Centre for Disease ControlVancouverCanada
  3. 3.Department of Pathology and Laboratory MedicineUniversity of British ColumbiaCanada
  4. 4.National Centre for StreptococcusEdmontonCanada
  5. 5.British Columbia Children’s HospitalCanada

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