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. 2024 May 24;50(5):121-134.
doi: 10.14745/ccdr.v50i05a02.

Invasive pneumococcal disease surveillance in Canada, 2021-2022

Averil Griffith  1 , Alyssa R Golden  1 , Brigitte Lefebvre  2 , Allison McGeer  3 , Gregory J Tyrrell  4 , George G Zhanel  5 , Julianne V Kus  6   7 , Linda Hoang  8 , Jessica Minion  9 , Paul Van Caeseele  10 , Hanan Smadi  11 , David Haldane  12 , Yang Yu  13 , Xiaofeng Ding  14 , Laura Steven  15 , Jan McFadzen  16 , Kristyn Franklin  17 , Irene Martin  1
Affiliations

Invasive pneumococcal disease surveillance in Canada, 2021-2022

Averil Griffith et al. Can Commun Dis Rep. .

Abstract

Background: Invasive pneumococcal disease (IPD, Streptococcus pneumoniae) has been a nationally notifiable disease in Canada since 2000. The use of conjugate vaccines has caused a shift in the distribution of serotypes over time. This report is a summary of the demographics, serotypes and antimicrobial resistance of IPD isolates collected in Canada in 2021 and 2022.

Methods: The National Microbiology Laboratory (NML) of the Public Health Agency of Canada in Winnipeg, Manitoba collaborates with provincial and territorial public health laboratories to conduct national surveillance of IPD. There were 1,999 isolates reported in 2021 and 3,775 isolates in 2022. Serotype was determined by the Quellung reaction or whole-genome sequencing (WGS). Antimicrobial susceptibilities were determined by WGS methods, broth microdilution, or data shared by collaborators in the Canadian Antimicrobial Resistance Alliance program at the University of Manitoba. Population-based IPD incidence rates were obtained through the Canadian Notifiable Disease Surveillance System.

Results: The incidence of IPD in Canada was 5.62 cases per 100,000 population in 2021, decreasing from the peak of 10.86 cases per 100,000 population in 2018. Serotypes with increasing trends (p<0.05) between 2018 and 2022 included: 4 (6.1%-12.4%), 9V (1.0%-5.1%) and 12F (4.8%-5.4%). The overall prevalence of PCV13 serotypes increased over the same period (31.2%-41.5%, p<0.05) while the prevalence of non-vaccine types decreased significantly (27.3%-21.5%, p<0.0001). The highest rates of antimicrobial resistance in 2021 and 2022 were seen with clarithromycin (21%, 2021; 24%, 2022) and erythromycin (22%, 2021; 24%, 2022). Multidrug-resistant IPD continued to increase from 2018 to 2022 (6.7%-12.6%, p<0.05).

Conclusion: The number of cases of IPD continued to decrease in 2021 in comparison to previous years, however, 2022 saw a return to pre-COVID-19 levels. Disease due to PCV13 serotypes 3, 4, 9V and 19F, as well as non-PCV13 serotypes 12F and 20, is increasing in prevalence. Surveillance of IPD to monitor changing serotype distribution and antimicrobial resistance is essential.

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

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Conflict of interest statement

Competing interests None.

Figures

Figure 1
Figure 1
Annual incidence of invasive pneumococcal disease cases per 100,000 population in Canada by age group, 2009–2021a a Data from Canadian Notifiable Disease Surveillance System (CNDSS); 2022 data not available at time of writing
Figure 2
Figure 2
Invasive Streptococcus pneumoniae serotype prevalence trends by age, 2018–2022a,b,c,d,e,f,g a Component of PCV13 b Component of PCV15 c Component of PCV20 d Component of PPV23 e Number of isolates for 2018, 2019, 2020, 2021 and 2022, respectively f For serotypes with an overall (2018–2022) N≥30: up or down arrows indicate statistically significant trends toward increasing or decreasing prevalence for the 2018–2022 timespan, using the chi-squared test for trend. Serotypes with no arrow either did not demonstrate a statistically significant trend, or did not have an overall N≥30 g Serotypes 15B and 15C were grouped together as 15B/C because of reported reversible switching between them in vivo during infection, making it difficult to precisely differentiate between the two types (18,19). Trends for more detailed age groups can be found in the Appendix, Figures S8 to S12
Figure 3
Figure 3
Invasive Streptococcus pneumoniae serotype trends by vaccine and agea, 2018–2022 Abbreviations: NVT, non-vaccine serotype; PCV, pneumococcal conjugate vaccine; PPCV, pneumococcal polysaccharide vaccine a Vaccine serotypes include PCV13 (1, 3, 4, 5, 6A/C, 6B, 7F, 9V, 14, 19A, 19F, 18C, 23F); PCV15 (all PCV13 serotypes plus 22F and 33F); PCV20 (all PCV15 serotypes plus 8, 10A, 11A, 12F, 15B/C) and PPV23 (PCV20 serotypes except 6A, plus 2, 9N, 17F, 20); NVT=all serotypes not included in PCV13, PCV15, PCV20 and PPV23. Trends for more detailed age groups can be found in the Appendix, Figures S18 to S23 and Tables S2 to S8
Figure 4
Figure 4
Annual trend of multidrug resistance of invasive Streptococcus pneumoniae, 2018–2022a a Antimicrobial classes include: beta-lactams (amoxicillin/clavulanic acid, penicillin using meningitis breakpoints, ceftriaxone using meningitis breakpoints, imipenem, and meropenem); macrolides (clarithromycin); fluoroquinolones (levofloxacin); tetracyclines (doxycycline); folate pathway inhibitors (trimethoprim-sulfamethoxazole); phenicols (chloramphenicol); lincosamides (clindamycin); and oxazolidinones (linezolid)
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References

    1. Scelfo C, Menzella F, Fontana M, Ghidoni G, Galeone C, Facciolongo NC. Pneumonia and Invasive Pneumococcal Diseases: The Role of Pneumococcal Conjugate Vaccine in the Era of Multi-Drug Resistance. Vaccines (Basel) 2021;9(5):420. 10.3390/vaccines9050420 - DOI - PMC - PubMed
    1. Ganaie F, Saad JS, McGee L, van Tonder AJ, Bentley SD, Lo SW, Gladstone RA, Turner P, Keenan JD, Breiman RF, Nahm MH. A New Pneumococcal Capsule Type, 10D, is the 100th Serotype and Has a Large cps Fragment from an Oral Streptococcus. MBio 2020;11(3):e00937–20. 10.1128/mBio.00937-20 - DOI - PMC - PubMed
    1. Bettinger JA, Scheifele DW, Kellner JD, Halperin SA, Vaudry W, Law B, Tyrrell G; Canadian Immunization Monitoring Program, Active (IMPACT) . The effect of routine vaccination on invasive pneumococcal infections in Canadian children, Immunization Monitoring Program, Active 2000-2007. Vaccine 2010;28(9):2130–6. 10.1016/j.vaccine.2009.12.026 - DOI - PubMed
    1. Demczuk WH, Martin I, Griffith A, Lefebvre B, McGeer A, Lovgren M, Tyrrell GJ, Desai S, Sherrard L, Adam H, Gilmour M, Zhanel GG; Toronto Bacterial Diseases Network; Canadian Public Health Laboratory Network . Serotype distribution of invasive Streptococcus pneumoniae in Canada after the introduction of the 13-valent pneumococcal conjugate vaccine, 2010-2012. Can J Microbiol 2013;59(12):778–88. 10.1139/cjm-2013-0614 - DOI - PubMed
    1. Desai S, McGeer A, Quach-Thanh C, Elliott D. Update on the Use of Conjugate Pneumococcal Vaccines in Childhood: An Advisory Committee Statement (ACS). National Advisory Committee on Immunization (NACI). Can Commun Dis Rep 2010;36(ACS-12):1–21. 10.14745/ccdr.v36i00a1210.14745/ccdr.v36i00a12 - DOI - DOI - PMC - PubMed