Background: In Ontario, PCV7 was publicly funded in Jan/2005 (3+1 schedule), PCV10 in Oct/09 and PCV13 in Nov/10 (2+1 schedule with catchup for up to 35mos old). TIBDN performs population-based surveillance for invasive pneumococcal disease (IPD) in Toronto/Peel to evaluate program impact.
Methods: IPD cases are reported to a central office and 1 isolate/case is serotyped (ST). Demographic and clinical data are collected by chart review and patient/physician interview.
Results: From 2001-15, 6594 IPD cases were identified and ST was available for 6046 (92%). 16% of cases were aged <15 yrs). 28% required ICU admission. Presenting diagnosis were pneumonia (68%), bacteremia without focus (17%) and meningitis (7%).
Since the introduction of PCVs, nonPCV ST IPD has increased from 2.6 to 4/100000/yr in adults and from 1.3 to 3.5/100000/yr in children (2001/4 vs 2013/5). IPD due to ST23A has increased in adults from 0.10.2 in 2001/4 to 0.30.4/100000/yr in 2013/5; and from no cases in children in 2001/7 to 0.20.6/100000/yr in 2013/5.
In 2014/5, STs were available for 88% of cases; STs 22F (12%), 19A (10%), 3 (9%), and 23A (7%) were the most common in adults. STs 19A (22%), 22F (10%), 3 (10%), 15B (8%), and 15C (8%) were the most common in children. NonPCV STs represented 70% of cases in 2015.
From 2013Mar/2016, 165 pediatric IPD cases were identified. ST was available for 143 (87%). 45 were due to PCV13/non7 STs. Seven were ineligible for PCV13 (aged >35 months when catch-up program was implemented or <2mos of age or immigrated to Ontario at age >35mos).
Vaccine history was available for 34 PCV13 vaccine-eligible children with PCV13/non7 ST disease (10 in 2013, 14 in 2014, 7 in 2015, and 3 in Jan-Mar 2016 ). 6 were unvaccinated (4 ST19A, 2 ST3), 11 missed ≥1 scheduled doses (8 ST19A, 2 ST3, 1 ST7F); 7 were eligible for a single dose only (2 ST19A, 5 ST3); 1 (ST3) was a child (11 mos) who received doses at 2 and 4 mos; and 9 were vaccine failures (6 ST19A, 2 ST3, 1 ST5).
Conclusion: Since PCV13-program implementation, the IPD rate due to PCV13/not7 STs has decreased in children and adults. NonPCV ST IPD has increased and in 2015 represented 70% of cases.
K. Green, None
J. Li, None
S. Pong-Porter, None
A. Plevneshi, None
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