447. Impact of a 13-valent Conjugant Pneumococcal Vaccine Program on Rates of Invasive Pneumococcal Disease, Toronto, Canada
Session: Poster Abstract Session: Pneumococcal Vaccine in Children and Adults
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C

Background: PCV7 vaccination has resulted in dramatic declines in IPD due to strains included in PCV7, but increases in IPD due to some non-conjugate vaccine strains (NCVT). We report on monitoring the effectiveness of 10- and 13-valent PCV infant vaccination programs in Ontario.

Methods: In Ontario, PCV7 was authorized in 2001, publicly funded PCV7 introduced in 1/2005 (3+1), PCV10 in 10/2009 (3+1) and PCV13 in 11/2010 (2+1). The PCV13 program included a catch-up dose for children aged 12-36m who had not previously received PCV13.TIBDN has performed population-based surveillance for IPD in Toronto/Peel region since 1995. Microbiology laboratories report all cases of IPD to a central study office. Isolates are shipped to a central study lab for serotyping. Clinical and vaccine data are collected by chart review and patient/physician interview.

Results: From 1/1/2001 to present, 1036 cases of pediatric IPD (<15y) were identified. 575 (56%) cases were male; 150 (15%) had chronic underlying illness predisposing to IPD. The most common diagnoses are pneumonia (408, 40%), bacteremia without focus (358, 35%), meningitis (98, 9.5%). 93 (9%) required ICU admission; the case fatality rate was 2.3% (24 deaths). IPD incidence was stable from 1995-02. Incidence of conjugate vaccine serotypes (STs) since 2006 is shown in 6 mo intervals by ST category for children aged 6-35 mos (vaccine eligible) in the Figure.

In 2012/13 (12-29 mos post PCV13 program implementation), 50% (14/28) PCV13 ST cases occurred in vaccine eligible children. ST and vaccine data are available for 61 of 65 cases. 33 were NCVT disease; 14 occurred in children not eligible for PCV13; 1 child was unvaccinated (ST 19A); 3 (2 19A, 1 3) had missed doses (2 with 1 dose of PCV13 only and 1 with primary PCV10 series without PCV13 booster); 7 (5 19A, 2 7F) had appropriately received PCV7 series and missed the PCV13 catch-up; 2 (18C, 19A) had received PCV13 at 2 and 4 mos, and developed IPD at 10 and 11 mos of age, respectively. One apparently healthy 5 year old developed empyema due to ST5 after age-appropriate vaccination with 2 PCV10 doses followed by 2 PCV13 doses.

Conclusion: In year 2 after PCV13 implementation, 89% of PCV13 ST disease occurred in children either not eligible for PCV13 or eligible but unvaccinated. The rate of PCV13/not7 disease is decreasing in vaccine eligible children.

Karen Green, MSc1, Wallis Rudnick, MSc2, Altynay Shigayeva, PhD2 and Toronto Invasive Bacterial Diseases Network, (1)Toronto Invasive Bacterial Diseases Network (TIBDN), Mt. Sinai Hospital, Toronto, ON, Canada, (2)Mount Sinai Hospital, Toronto, ON, Canada

Disclosures:

K. Green, Pfizer: Grant Investigator, Educational support, Research grant and Research support
GSK: Grant Investigator, Research support

W. Rudnick, None

A. Shigayeva, None

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