Invasive pneumococcal disease surveillance in Canada, 2020

Alyssa Golden; Averil Griffith; Walter Demczuk; Brigitte Lefebvre; Allison McGeer; Gregory Tyrrell; George Zhanel; Julianne Kus; Linda Hoang; Jessica Minion; Paul Van Caeseele; Hanan Smadi; David Haldane; George Zahariadis; Kristen Mead; Laura Steven; Lori Strudwick; Anita Li; Michael Mulvey; Irene Martin

Invasive pneumococcal disease surveillance in Canada, 2020

Can Commun Dis Rep. 2022 Sep 1;48(9):396-406.

Authors

Alyssa Golden¹, Averil Griffith¹, Walter Demczuk¹, Brigitte Lefebvre², Allison McGeer³, Gregory Tyrrell⁴, George Zhanel⁵, Julianne Kus^{6

7}, Linda Hoang⁸, Jessica Minion⁹, Paul Van Caeseele¹⁰, Hanan Smadi¹¹, David Haldane¹², George Zahariadis¹³, Kristen Mead¹⁴, Laura Steven¹⁵, Lori Strudwick¹⁶, Anita Li¹⁷, Michael Mulvey^{1

5}, Irene Martin¹

Affiliations

¹ National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB.
² Laboratoire de santé publique du Québec, Sainte-Anne-de- Bellevue, QC.
³ Toronto Invasive Bacterial Diseases Network (TIBDN), Department of Microbiology, Mount Sinai Hospital, Toronto, ON.
⁴ Provincial Laboratory for Public Health (Microbiology), Edmonton, AB.
⁵ Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB.
⁶ Public Health Ontario, Toronto, ON.
⁷ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON.
⁸ British Columbia Centre for Disease Control, Vancouver, BC.
⁹ Roy Romanow Provincial Laboratory, Regina, SK.
¹⁰ Cadham Provincial Laboratory, Winnipeg, MB.
¹¹ New Brunswick Department of Health, Fredericton, NB.
¹² Queen Elizabeth II Health Science Centre, Halifax, NS.
¹³ Newfoundland and Labrador Public Health Laboratory, St. John's, NL.
¹⁴ Queen Elizabeth Hospital, Charlottetown, PE.
¹⁵ Stanton Territorial Hospital Laboratory, Yellowknife, NT.
¹⁶ Yukon Communicable Disease Control, Whitehorse, YT.
¹⁷ Centre for Immunization & Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON.

PMID: 38124782
PMCID: PMC10732480

Abstract

Background: Invasive pneumococcal disease (IPD), which is caused by Streptococcus pneumoniae, has been a nationally notifiable disease in Canada since 2000. The use of conjugate vaccines has markedly decreased the incidence of IPD in Canada; however, the distribution of serotypes has shifted in favour of non-vaccine types. This report summarizes the demographics, serotypes and antimicrobial resistance of IPD infections in Canada in 2020.

Methods: The Public Health Agency of Canada's National Microbiology Laboratory (Winnipeg, Manitoba) collaborates with provincial and territorial public health laboratories to conduct national surveillance of IPD. A total of 2,108 IPD isolates were reported in 2020. Serotyping was performed by Quellung reaction and antimicrobial susceptibilities were determined in collaboration with the University of Manitoba/Canadian Antimicrobial Resistance Alliance. Population-based IPD incidence rates were obtained through the Canadian Notifiable Disease Surveillance System.

Results: Overall incidence of IPD in Canada decreased significantly from 11.5 (95% confidence interval [CI]: 10.1-13.1) to 6.0 (95% CI: 5.0-7.2), and from 10.0 (95% CI: 9.7-10.3) to 5.9 (95% CI: 5.7-6.2) cases per 100,000 from 2019 to 2020; in those younger than five years and those five years and older, respectively. The most common serotypes overall were 4 (11.2%, n=237), 3 (10.9%, n=229) and 8 (7.2%, n=151). From 2016 to 2020, serotypes with increasing trends (p<0.05) included 4 (6.4%-11.2%), 3 (9.5%-10.9%), 8 (5.2%-7.2%) and 12F (3.6%-5.7%). The overall prevalence of PCV13 serotypes increased over the same period (30.3%-34.9%, p<0.05). Antimicrobial resistance rates in 2020 included 23.0% clarithromycin and 9.9% penicillin (IV meningitis breakpoints). Multidrug-resistant IPD has significantly increased since 2016 (4.2%-9.5%, p<0.05).

Conclusion: Though the incidence of IPD decreased in 2020 in comparison to previous years across all age groups, disease due to PCV13 serotypes 3 and 4, as well as non-PCV13 serotypes such as 8 and 12F, increased in prevalence. Continued surveillance of IPD is imperative to monitor shifts in serotype distribution and antimicrobial resistance.

Keywords: Canada; IPD; PCV13; Streptococcus pneumoniae; antimicrobial resistance; invasive pneumococcal disease; pneumococcus; serotype; surveillance.