Burden of vaccine-preventable pneumococcal disease in hospitalized adults: A Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network study

Abstract

In total, 4769 all-cause CAP cases and 81 cases of IPD (non-CAP) were identified. Of the 4769 all-cause CAP cases, a laboratory test for S. pneumoniae was performed in 3851, identifying 14.3% as CAP. Of CAP cases among whom all four diagnostic test were performed, S. pneumoniae was identified in 23.2% (144/621). CAP cases increased with age and the disease burden of illness was evident in terms of requirement for mechanical ventilation, intensive care unit admission, and 30-day mortality. Of serotypeable CAP or IPD results, predominance for serotypes 3, 7F, 19A, and 22F was observed. The proportion of hospitalized CAP cases caused by a PCV13-type S. pneumoniae ranged between 7.0% and 14.8% among cases with at least one test for S. pneumoniae performed or in whom all four diagnostic tests were performed, respectively. Overall, vaccine-preventable pneumococcal CAP and IPD were shown to be significant causes of morbidity and mortality in hospitalized Canadian adults in the three years following infant PCV13 immunization programs in Canada.

Assessing the diagnostic accuracy of PCR-based detection ofStreptococcus pneumoniaefrom nasopharyngeal swabs collected for viral studies in Canadian adults hospitalised with community-acquired pneumonia: a Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research (CIRN) study

“…16 Of the 4769 cases of all-cause CAP enrolled from 1 December 2010 to 31 December 2013, 434 had NP swabs for viral Figure 1 Diagram illustrating the flow of participants and a summary of laboratory results based on disease categories. Community-acquired pneumonia (CAP) cases were considered if a nasopharyngeal (NP) swab was available and all (A) or any (B) of the following tests were performed: sputum culture (SC), blood culture (BC), a pan-pneumococcal urine antigen detection (UAD Spn ) and/or a 13-valent pneumococcal conjugate vaccine serotype-specific UAD (UAD PCV13 ).…”

“…16 The CIRN SOS Network has been conducting active surveillance for CAP and invasive pneumococcal disease (IPD) in hospitalised adults since December 2010 at nine acute care hospitals spanning five Canadian provinces (British Columbia, Ontario, Québec, New Brunswick and Nova Scotia). 16 Dedicated surveillance monitors reviewed daily adult admissions (aged ≥16 years) to medical wards or intensive care units (ICUs) to identify patients with an acute respiratory illness, which were admitted from the community or another acute care hospital with influenza virus infection, CAP, asthma or acute exacerbation of chronic obstructive pulmonary disease, or any other respiratory tract infection or symptoms. Patients were eligible for enrolment if they met the study case definition for CAP.…”

“…In addition, these serotypes and those obtained from NP-positive non-CAP Spn cases all showed predominance for serotypes 3, 7F, 19A and 22F, as previously noted in this patient population. 16 dIscussIon Laboratory tools for the detection and serotyping of S. pneumoniae are important to monitor the impact of pneumococcal vaccines, yet due to the high cost of disease surveillance, few studies go to the extent of comparing laboratory methods to clinical cases defined from CAP patient with pneumococcal disease. Compared with cases meeting the CAP definition, and with laboratory identification of S. pneumoniae from either culture-based or antigen-based laboratory tests, the performance of PCR-based detection and serotyping of S. pneumoniae from NP swabs collected for viral studies were evaluated.…”

Age-stratified burden of pneumococcal community acquired pneumonia in hospitalised Canadian adults from 2010 to 2015

“…Streptococcus pneumoniae (or pneumococcus) infections cause high morbidity and mortality worldwide, with significant impact on public health and healthcare resources 2–5. Individuals at risk include children aged ≤5 years, adults aged ≥65 years and individuals of any age with underlying medical conditions 1 5–12. The most serious manifestations of pneumococcal infection include invasive pneumococcal diseases (IPDs) and community-acquired pneumonia (CAP).…”

The Role of Streptococcus pneumoniae in Community-Acquired Pneumonia

“…16 Furthermore, an active surveillance study for pneumococcal CAP and invasive pneumococcal disease (IPD) was undertaken in adults hospitalized across five Canadian provinces from 2010 to 2013. 17 Diagnostic testing for pneumococcal CAP was undertaken using sputum and blood culture, a commercial pneumococcal urine antigen detection test and a serotype-specific pneumococcal urine antigen detection test. Of the total of 4,769 patients with all-cause CAP, testing for S. pneumoniae was undertaken in 3,851 of these, identifying 23.2% (144/621) of cases among CAP patients in whom all four tests were performed.…”