Estimating population-based incidence of community-acquired pneumonia and acute otitis media in children and adults in Ontario and British Columbia using health administrative data, 2005–2018: a Canadian Immunisation Research Network (CIRN) study

Nasreen, Sharifa; Wang, Jun; Sadarangani, Manish; Kwong, Jeffrey C.; Quach, Caroline; Crowcroft, Natasha S.; Wilson, Sarah E.; McGeer, Allison; Morris, Shaun K.; Kellner, James D.; Sander, Beate; Kus, Julianne V.; Hoang, Linda; Marra, Fawziah; Fadel, Shaza A

doi:10.1136/bmjresp-2022-001218

Cited by 6 publications

(3 citation statements)

References 49 publications

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“…10 We also observed a decrease in the incidence of outpatient and inpatient all-cause community-acquired pneumonia during the PCV13 period in Ontario and British Columbia (BC) in older adults. 11 The benefit of mature PCV13 childhood vaccination programmes on community protection for older adults in a Canadian context is unknown. In this study, we examined the impact of paediatric PCV13 vaccination programmes on IPD and all-cause pneumonia in older adults in two large Canadian provinces.…”

Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

Indirect impact of childhood 13-valent pneumococcal conjugate vaccine (PCV13) in Canadian older adults: a Canadian Immunization Research Network (CIRN) retrospective observational study

Nasreen,

Wang,

Marra

et al. 2024

Thorax

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Background13-valent pneumococcal conjugate vaccine (PCV13) has been part of publicly funded childhood immunisation programmes in Ontario and British Columbia (BC) since 2010. We assessed the indirect impact of infant PCV13 programmes on invasive pneumococcal disease (IPD) and all-cause pneumonia hospitalisation in older adults (aged ≥65 years) using a retrospective observational study.MethodsWe extracted monthly IPD and all-cause pneumonia cases from laboratory and health administrative databases between January 2005 and December 2018. Using a quasi-experimental difference-in-differences design, we calculated the ratio of risk ratios (RRRs) using incidence rates of IPD or all-cause pneumonia cases before (pre-PCV13 period) and after (PCV13 period) 2010 with rates of fractures as controls.ResultsThe rates of all IPD or PCV serotype-specific IPD for older adults in both Ontario and BC did not change in 8 years after childhood PCV13 programme implementation. All-cause pneumonia increased in Ontario (RRR 1.38, 95% CI 1.11 to 1.71) but remained unchanged in BC.ConclusionsIndirect community protection of older adults from hospitalisation with pneumococcal disease stalled despite maturation of childhood PCV13 vaccination programmes in two Canadian provinces.

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Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

Indirect impact of childhood 13-valent pneumococcal conjugate vaccine (PCV13) in Canadian older adults: a Canadian Immunization Research Network (CIRN) retrospective observational study

Nasreen,

Wang,

Marra

et al. 2024

Thorax

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“…The primary age of onset of AOM is in newborns and children between 4 months and 3 years. It is assumed that an anatomically shorter and more horizontally oriented eustachian tube promotes easier migration of pathogens into the middle ear ( 15 ). Previous studies on the influence of meteorologic factors on AOM occurrence have, therefore, focused on the pediatric population, neglecting AOM-related EVs in adults ( 8 , 9 , 16 ).…”

Section: Introductionmentioning

confidence: 99%

Fluctuations in emergency department visits related to acute otitis media are associated with extreme meteorological conditions

Nieratschker

Haas

Lucic

et al. 2023

Front. Public Health

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BackgroundClimate change has been associated with a higher frequency of extreme weather events, resulting in an overall increase in morbidity and mortality. Acute otitis media (AOM) is one of the most common otolaryngological infections and accounts for 1.5% of emergency department visits. This study aimed to identify associations between extreme weather events and the immediate and delayed risks for AOM-related emergency department visits (EV).MethodsA total of 1,465 AOM-related EVs were identified in the Vienna General Hospital between 2015 and 2018. A distributed lag non-linear model was applied to evaluate the relationship between extreme weather conditions and the total number of AOM-related EVs per day. The relative risk (RR) and cumulative RR (cRR) of single-day events and extended weather events over three days were analyzed over a lag period of 14 days.ResultsAOM-related EVs showed a pronounced seasonality, with the highest occurrence during winter. Single-day weather events affected AOM-related EVs only at high relative humidity. Prolonged extreme weather conditions over three days, however, significantly increased the cRR for AOM-related EVs to 3.15 [1.26–7.88; p = 0.014] and 2.14 [1.14–4.04; p = 0.018] at mean temperatures of −4°C (1st-percentile - p1) and 0°C (p5) on the same day. Relative humidity of 37% (p1) decreased RR to 0.94 [0.88–0.99; p = 0.032] on day 7, while extremely high humidity of 89% (p99) led to an increased cRR of 1.43 [1.03–2.00; p = 0.034] on day 7. Heavy prolonged precipitation of 24mm (p95) reduced cRR beginning day 4 up until day 14 to 0.52 [0.31–0.86; p = 0.012]. Prolonged low atmospheric pressure events of 985hPa (p5) reduced the RR to 0.95 [0.91–1.00; p = 0.03], whereas extremely high atmospheric pressure events of 1013hPa (p99) increased the RR to 1.11 [1.03–1.20; p = 0.008]. Extremely low wind speeds significantly diminished the RR of AOM-related EVs.ConclusionsWhile single-day extreme weather events had little impact on the occurrence of AOM-related EVs, extended periods of extreme temperatures, relative humidity, precipitation, wind speeds and atmospheric pressure significantly impacted the RR for AOM-related EVs. These findings could help improve healthcare resource allocation in similar climates and aid in educating patients about the role of environmental factors in AOM.

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“…Moreover, despite the polysaccharide pneumococcal vaccine being available in Canada through publicly-funded immunization programs since the 1990s, annual rates of CAP have continued to rise, with 212 additional incident cases per 100,000 in the province of British Columbia (BC) by 2018 (compared to 2010), and 239 in Ontario (ON) [6]. Highest infection rates continue to be reported in the elderly populations [7]. Adherence to clinical guidelines in antibiotic treatment selection has been associated with improved patient outcomes, and reduced healthcare costs [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Retrospective cohort analysis of outpatient antibiotic prescribing for community-acquired pneumonia in Canadian older adults

Saatchi,

Reid,

Shariff

et al. 2023

PLoS ONE

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Background This retrospective cohort study is the first in North America to examine population-level appropriate antibiotic use for community-acquired pneumonia (CAP) in older adults, by agent, dose and duration. With the highest rates of CAP reported in the elderly populations, appropriate antibiotic use is essential to improve clinical outcomes. Given the ongoing crisis of antimicrobial resistance, understanding inappropriate antibiotic prescribing is integral to direct community stewardship efforts. Methods All outpatient primary care visits for CAP (aged ≥65 years) were identified using physician billing codes between January 1 2014 to December 31 2018 in British Columbia (BC) and Ontario (ON). Categories of prescribing were derived from existing literature, and constructed for clinical relevance using Canadian and international guidelines available during the study period. Categories were mutually exclusive and included: guideline adherent (first-line agent, adherent dose/duration), clinically appropriate (non-first line agent, presence of comorbidities), effective but unnecessary (first-line agent, excess dose/duration), undertreatment (first-line agent, subtherapeutic dose/duration), and not recommended (non-first line agent, absence of comorbidities). Proportions of prescribing were examined by category. Temporal trends in prescribing were examined using Poisson regression. Results A total of 436,441 episodes of CAP were identified, with 46% prescribed an antibiotic in BC, and 52% in Ontario. Guideline adherent prescribing was minimal for both provinces (BC: 2%; ON: 1%) however the largest magnitude of increase was reported in this category by the final study year (BC—Rate Ratio [RR]: 3.4, 95% Confidence Interval [CI]: 2.7–4.3; ON—RR: 4.62, 95% CI: 3.4–6.5). Clinically appropriate prescribing accounted for the most antibiotics issued, across all study years (BC: 61%; ON: 74%) (BC—RR: 0.8, 95% CI: 0.8–0.8; ON—RR: 0.9, 95% CI: 0.8–0.9). Excess duration of therapy was the hallmark characteristic for effective but unnecessary prescribing (BC: 92%; ON: 99%). The most common duration prescribed was 7 days, followed by 10. Not recommended prescribing was minimal in both provinces (BC: 4%; ON: 7%) and remained stable by the final study year (BC—RR: 1.1, 95% CI: 0.9–1.2; ON—RR: 0.9, 95% CI: 0.9–1.1). Conclusion Three quarters of antibiotic prescribing for CAP was appropriate in Ontario, but only two thirds in BC. Shortening durations—in line with evidence for 3 to 5-day treatment presents a focused target for stewardship efforts.

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Estimating population-based incidence of community-acquired pneumonia and acute otitis media in children and adults in Ontario and British Columbia using health administrative data, 2005–2018: a Canadian Immunisation Research Network (CIRN) study

Cited by 6 publications

References 49 publications

Indirect impact of childhood 13-valent pneumococcal conjugate vaccine (PCV13) in Canadian older adults: a Canadian Immunization Research Network (CIRN) retrospective observational study

Indirect impact of childhood 13-valent pneumococcal conjugate vaccine (PCV13) in Canadian older adults: a Canadian Immunization Research Network (CIRN) retrospective observational study

Fluctuations in emergency department visits related to acute otitis media are associated with extreme meteorological conditions

Retrospective cohort analysis of outpatient antibiotic prescribing for community-acquired pneumonia in Canadian older adults

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