Background: COPD is the 4th leading cause of death in the US. Patients with COPD are one potential population for new pneumococcal vaccines. We reviewed population-based surveillance data in Toronto, Canada, to assess the burden of illness due to invasive pneumococcal disease (IPD) in persons with COPD.
Methods: We report data from population-based surveillance for IPD in Toronto/ Peel region since 1995. Cases are reported to a central study lab; antibiotic susceptibility and serotyping are performed. Patient information is collected by interview and chart review. Vaccine efficacy (VE) was estimated by the indirect cohort method.
Results: 1269/ 8641 (14.7%) adults IPD cases had underlying COPD. The average annual incidence of IPD in COPD patients from 2004-2015 was 6.0/100,000 for those aged 15-49y, 12.7/100,000 for those aged 50-64y, and 27.5/100,000 in those aged 65+. Median age was 74y (range 31-103y; 72% age≥65). Among cases with available data, 620/859 (72%) had received influenza vaccine in the previous fall, 398/832 (48%) had received pneumococcal polysaccharide vaccine (PPSV), and 359/937 (38%) were current smokers. There were1073 cases of pneumonia (33 with empyema), 113 primary bacteremia, 21 meningitis, 54 other diagnoses. 418 (33%) required ICU admission, (28%) died during the hospitalization. The median length of stay (LOS) was 9 days (mean 19, IQR 4-19). VE for PPSV was 32% (95% CL 5%-50%). The case fatality decreased over time (205/666, 31% 1995-2005 vs. 145/454 2006-2015, P<.001), ICU admission increased (199/660, 3% vs. 219/602, 36%, P=.02) and LOS did not change. Incidence over time by serotype category is shown in Figure 1: herd immunity has substantially reduced disease due to PCV7 serotypes. The distribution of serotypes is different in patients with and without underlying COPD (Figure 2). In 2014/15, in patients with COPD, serotypes included in PCV7 caused 5.3% of disease, compared to 37.8% caused by additional PCV13 serotype, 22% by PPSV/non-PCV serotypes, and 35% by non-vaccine types.
Conclusion: Despite the benefits of PPV23 in individual adults, herd immunity associated with pediatric PCV programs and declining case fatality, IPD burden in COPD patients is substantial. Use of PCV13, and new vaccines are needed to reduce this burden.
K. Green, None
J. Li, None
S. Pong-Porter, None
A. Plevneshi, None
J. C. Kwong, None