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. 2011;6(12):e28547.
doi: 10.1371/journal.pone.0028547. Epub 2011 Dec 27.

Community-based outbreaks in vulnerable populations of invasive infections caused by Streptococcus pneumoniae serotypes 5 and 8 in Calgary, Canada

Otto G Vanderkooi  1 , Deirdre L Church, Judy MacDonald, Franziska Zucol, James D Kellner
Affiliations

Community-based outbreaks in vulnerable populations of invasive infections caused by Streptococcus pneumoniae serotypes 5 and 8 in Calgary, Canada

Otto G Vanderkooi et al. PLoS One. 2011.

Abstract

Background: Outbreaks of invasive pneumococcal disease (IPD) typically occur within institutions. Beginning in 2005, we detected an increase in serotype (ST) 5 and ST8 IPD cases, predominantly in homeless persons living in an open community.

Methodology/principal findings: CASPER (Calgary Area S. pneumoniae Epidemiology Research) surveillance study of all IPD (sterile site isolates) in our region (pop ~1,100,000). Interviews and chart reviews of all cases and all isolates phenotypically analyzed and selected isolated tested by multi-locus sequence typing (MLST).

Conclusions/significance: During 2005-2007, 162 cases of ST5 IPD and 45 cases of ST8 IPD were identified. The isolates demonstrated phenotypic and genotypic clonality. The ST5 isolates were sequence type (ST) 289 and demonstrated intermediate susceptibility to TMP-SMX. The ST8 isolates were predominantly ST1268, with a susceptible antimicrobial susceptibility profile. Individuals with ST5 IPD were more likely to be middle aged (OR 2.6), homeless (OR 4.4), using illicit drugs(OR 4.8), and asthmatic(OR 2.6). Those with ST8 were more likely to be male (OR 4.4), homeless (OR 2.6), aboriginal (OR7.3), and a current smoker (OR 2.5). Overlapping outbreaks of ST5 and ST8 IPD occurred in an open community in Calgary, Canada and homelessness was a predominant risk factor. Homelessness represents a unique community in which pneumococcal outbreaks can occur.

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Conflict of interest statement

Competing Interests: JDK has served as a consultant to Wyeth (Pfizer) and GlaxoSmithKline and has received research grants from Wyeth (Pfizer) for Surveillance and Vaccine Evaluation Projects and from Wyeth (Pfizer) and GSK for vaccine clinical trials. OGV has received research grants from Wyeth (Pfizer) and GSK for vaccine clinical trials. He has participated in an expert panel meeting for GSK and Novartis. JM, FZ and DLC declare no conflicts of interest. This does not alter the authors′ adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Incidence of Invasive Streptococcus pneumoniae Infections, highlighting outbreaks with serotype 5 and 8, in the Calgary Health Region, 1998–2009.
Figure 2
Figure 2. Epidemic Curve of Streptococcus pneumoniae Serotype 5 Outbreak in Patients Greater Than 16 Years of Age, Calgary Health Region, 2005–2007.
Figure 3
Figure 3. Epidemic Curve of Streptococcus pneumoniae ST8 Outbreak in Patients Greater Than 16 Years of Age, Calgary Health Region, 2005–2007.
See this image and copyright information in PMC

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