1426. Impact of Routine Pediatric PCV13 on the Incidence and Severity of Invasive Pneumococcal Disease in Adults in Ontario, Canada.
Session: Poster Abstract Session: Pneumococcal Vaccines
Friday, October 5, 2018
Room: S Poster Hall

Background: Monitoring the incidence and severity of disease due to varied pneumococcal (Pn) serotypes (STs) over time is important in assessing the benefit of Pn vaccines.  We describe changes in adult IPD after the 2010 introduction of routine infant PCV13 in Ontario, Canada (PCV13 is funded only for immunocompromised adults ≥50y as of 2015).

Methods: TIBDN has conducted population-based surveillance for IPD in Toronto/Peel, Canada (pop 4.3M) since 1995. Cases are reported to a central office; 1 isolate/case is serotyped. Demographic and clinical data are collected by chart review and patient/family physician interview.

Results: Of 6275 episodes of adult IPD, 5674 (90%) have STs and 6007 (96%) detailed clinical data. Incidence of IPD decreased from 14.2/100000/y in 1995 to 6.0/100000/y in 2013–17). 1203 (19%) adults with IPD were 15-44y, 1889 (30%) were 45-64y, 3182 (51%) ≥65y. Figures 1&2 show rates over time by ST group and age. In multivariable analyses, there was no difference across vaccine ST groups (non-vaccine type (NVT) vs. PPV23 not PCV vs PCV13) in patient age, proportion with ICU admission, requirement for mechanical ventilation (MV), death, length of stay (LOS) or diagnosis of meningitis, except that patients with NVT isolates were more likely to require ICU admission (OR 1.5, 95%CI 1.2,2.0), and to have meningitis (OR 1.9, 95%CI 1.1,3.3).  Case fatality declined from 25% (480/1949) 1995-2001 to 19% (148/763) in 2012-17 (multivariable OR/y 0.98 95%CI 0.97,0.99);  requirements for ICU admission (26%-31%; OR/y 1.02, 95%CI 1.01,1.03) and MV (OR/y 18-22%; 1.02, 95%CI 1.01-1.03) increased, LOS did not change. From 2013-17, the distribution of vaccine group STs has not changed:  37% PCV13 (383/1031); 20% PCV20not13 (205); 9% PPV23not 20 (94), 34% NVT (349). NVT strains include over 23 ST, most commonly 23A (72, 21%), 15A (46, 13%), 35B (37,11%), 6C (36, 10%), 23B (20, 8%).

Conclusion: In our population, with infant but no routine adult PCV13, the incidence of adult IPD appears to have stabilized, with PCV13 ST strains contributing 37% of IPD. Case fatality has decreased; ICU admission increased. Adult vaccination may be required to further reduce PCV13 ST infections.

Figure 1:  IPD Incidence, adults 15-65y, by ST group, 2006-17. Infant PCV7 started 2005 & PCV13 in 2010.

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Figure 1:  IPD Incidence, adults ≥65y, by ST group, 2006-17. Infant PCV7 started 2005 & PCV13 in 2010.

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Sarah Nayani, PhD1, Karen Green, MSc, RN2, Hedan Han, MSc3, Jeff Li, BSc2, Agron Plevneshi, BSc2, Wallis Rudnick, MSc.2, Allison McGeer, MD, MSc4 and Toronto Invasive Bacterial Diseases Network, (1)Microbiology, Sinai Heatlh System, Toronto, ON, Canada, (2)Mount Sinai Hospital, Toronto, ON, Canada, (3)Microbiology, Sinai Health System, Toronto, ON, Canada, (4)Infection Control, University of Toronto, Toronto, ON, Canada

Disclosures:

S. Nayani, None

K. Green, None

H. Han, None

J. Li, None

A. Plevneshi, None

W. Rudnick, None

A. McGeer, Pfizer: Grant Investigator and Scientific Advisor , Research grant and Research support . Merck: Scientific Advisor , Research support . GlaxoSmithKline: Grant Investigator and Scientific Advisor , Research support .

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