Abstract
Objective
In 2002, a mass immunization campaign using the 23-valent pneumococcal polysaccharide vaccine (PPV23) was carried out in Nunavik to control an outbreak caused by a virulent clone of serotype 1 Streptococcus pneumoniae. At the same time, the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced for routine immunization of infants, replaced by the 10-valent vaccine (PCV10) in 2009, and the 13-valent vaccine (PCV13) in 2011. The objective of this study was to describe the epidemiology of invasive pneumococcal disease (IPD) in relation to pneumococcal vaccine use.
Method
Retrospective analysis of IPD cases identified by the Quebec Public Health Laboratory during the period 1997–2016.
Results
One hundred thirty-two IPD cases were identified during the study period. In adults, serotype 1 incidence decreased following the 2002 PPV23 mass campaign, but breakthrough cases occurred. Following PCV use, the incidence of vaccine-type IPD decreased markedly in children and also in adults but serotypes not covered by conjugate vaccines increased. The overall IPD rate was 43/100,000 person-years in the 1997–1999 pre-vaccine era and 58/100,000 person-years in 2010–2016.
Conclusions
The 2002 PPV23 mass immunization campaign may have contributed to control the serotype 1 outbreaks in Nunavik, but its effect was short-lived as IPDs caused by serotypes included in this vaccine continued to occur after 2005. PCV use in children induced important modifications in the epidemiology of IPD, but most of the benefits were eroded by serotype replacement.
Résumé
Objectif
En 2002, une campagne de vaccination de masse avec le vaccin pneumococcique polysaccharidique 23-valent (VPPS23) eut lieu au Nunavik pour contrôler une épidémie due à un clone virulent de Streptococcus pneumoniae de serotype 1. Au même moment, le vaccin pneumococcique conjugué heptavalent (VPC7) était introduit au calendrier de vaccination des nourrissons, puis fût remplacé par un vaccin décavalent (VPC10) en 2009 et par un vaccin 13-valent (VPC13) en 2011. Le but de cette étude était de décrire l’épidémiologie des infections invasives à pneumocoques (IIP) en rapport avec l’utilisation des vaccins pneumococciques.
Méthode
Analyse rétrospective des cas d’IIP identifiés par le Laboratoire de Santé Publique du Québec (LSPQ) durant la période 1997-2017.
Résultats
132 cas d’IIP furent identifiés au cours de la période d’étude. Chez les adultes, l’incidence des IIP dues au sérotype 1 déclina suite à la campagne de vaccination de masse de 2002 mais plusieurs cas survinrent tout de même par la suite. Après l’introduction du VPC7, l’incidence des IIP causées par des sérotypes vaccinaux baissa fortement dans toute la population mais un remplacement de sérotypes fût observé. L’incidence globale des IIP était de 43/100 000 personne-années au cours de la période pré-vaccins 1997-1999 et de 58/100 000 personne-années au cours de la période 2010-2016.
Conclusions
La campagne de vaccination de masse de 2002 a probablement contribué à contrôler l’épidémie d’IIP dues au sérotype 1 mais son effet fût de courte durée puisque des IIP causées par des sérotypes couverts par ce vaccin ont continué à arriver après 2005. L’introduction du VPC chez les enfants a induit des changements importants dans l’épidémiologie des IIP mais la majeure partie des gains a été perdue à cause du remplacement de sérotypes.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bonesteel, S. (2008). Canada’s relationship with Inuit: a history of policy and program development. Ottawa: Indian and Northern Affairs Available at: http://publications.gc.ca/collections/collection_2010/ainc-inac/R3-82-2008-eng.pdf. Last access: July 2018.
Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Social Sciences and Humanities Research Council of Canada. (2010). Tri-council policy statement: ethical conduct for research involving humans, Chapter 9. Available at: http://www.pre.ethics.gc.ca/pdf/eng/tcps2/TCPS_2_FINAL_Web.pdf. Last access: July 2018.
Cléophat, J. E., Le Meur, J. B., Proulx, J. F., & De Wals, P. (2014). Uptake of pneumococcal vaccines in the Nordic region of Nunavik, province of Quebec, Canada. Canadian Journal of Public Health, 105(4), e268–e272.
Degani, N., Navarro, C., Deeks, S. L., & Lovgren, M. (2008). Invasive bacterial diseases in northern Canada. Emerging Infectious Diseases, 14, 34–40.
Douville-Fradet, M., Amini, R., Boulianne, N., Khuc, N.H., De Wals, P., Fortin, E. et al. (2011). Impact du programme d’immunisation par le vaccin pneumococcique conjugué heptavalent (VPC-7) au Québec. Québec: Institut national de santé publique du Québec, 99p. Available at: http://www.inspq.qc.ca/pdf/publications/1313_ImpactProgImmuVaccinVP7.pdf.
Durando, P., Faust, S. N., Fletcher, M., Krizova, P., Torres, A., & Welte, T. (2013). Experience with pneumococcal polysaccharide conjugate vaccine (conjugated to CRM197 carrier protein) in children and adults. Clinical Microbiology and Infection, 19(S1), 1–9.
Gouvernement du Québec. S-2.2. Loi sur la Santé publique. Chapitre VIII. Intoxications, infections et maladies à déclaration obligatoire. Available at : http://legisquebec.gouv.qc.ca/fr/ShowDoc/cs/S-2.2. Accessed 14 October 2018.
Feikin, D. R., Kagucia, E. W., Loo, J. D., Link-Gelles, R., Puhan, M. A., et al. (2013). Serotype-specific changes in invasive pneumococcal disease after pneumococcal conjugate vaccine introduction: a pooled analysis of multiple surveillance sites. PLoS Medicine, 10(9), e1001517. https://doi.org/10.1371/journal.pmed.1001517.
Hausdorff, W. P., & Hanage, W. P. (2016). Interim results of an ecological experiment — conjugate vaccination against the pneumococcus and serotype replacement. Human Vaccines & Immunotherapeutics, 12(2), 358–374. https://doi.org/10.1080/21645515.2015.1118593.
Hausdorff, W. P., Feikin, D. R., & Klugman, K. P. (2005). Epidemiological differences among pneumococcal serotypes. The Lancet Infectious Diseases, 5(2), 83–93.
Kawakami, K., Kishino, H., Kanazu, S., Toshimizu, N., Takahashi, K., Sterling, T., Wang, M., & Musey, L. (2016). Revaccination with 23-valent pneumococcal polysaccharide vaccine in the Japanese elderly is well tolerated and elicits immune responses. Vaccine, 34, 3875–3881. Available at:. https://doi.org/10.1016/j.vaccine.2016.05.052.
Lefebvre, B., Cote, J. (2015). Programme de surveillance du pneumocoque: Rapport 2014. Québec: Institut national de santé publique du Québec. Available at : https://www.inspq.qc.ca/sites/default/files/publications/2081_surveillance_pneumocoque.pdf.
Li, Y. A., Martin, I., Tsang, R., Squires, S. G., Demczuk, W., & Desai, S. (2016). Invasive bacterial diseases in northern Canada, 2006–2013. Canada Communicable Disease Report, 42, 74–80.
MacMillan, H. I., MacMillan, A. B., Offord, D. R., & Dingle, J. L. (1996). Aboriginal health. CMAJ, 155, 1569–1576.
Marcy, J. F., Roberts, A., Lior, L., Tam, T. W. S., & VanCaeseele, P. (2002). Outbreak of community-acquired pneumonia in Nunavut, October and November 2000. Canada Communicable Disease Report, 28, 131–138.
Moberley, S., Holden, J., Tatham, D. P., & Andrews, R. M. (2013). Vaccines for preventing pneumococcal infection in adults (Review). The Cochrane Database of Systematic Reviews, (1) Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000422.pub3/pdf.
Moore, M. R., Link-Gelles, R., Schaffner, W., et al. (2015). Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance. The Lancet Infectious Diseases, 15(3), 301–309.
Ndiaye, A. A., De Wals, P., Proulx, J. F., Ouakki, M., Jetté, L., & Déry, S. (2006). Impact of a mass immunization campaign to control an outbreak of severe respiratory infections in Nunavik, northern Canada. International Journal of Circumpolar Health, 65, 297–304.
Orenstein, W. A., Bernier, R. H., Dondero, T. J., Hinman, A. R., Marks, J. S., Bart, K. J., & Sirotkin, B. (1985). Field evaluation of vaccine efficacy. Bulletin of the World Health Organization, 63(6), 1055–1068.
Protocole d’immunisation du Québec. Édition 6. Ministère de la santé et des services Sociaux du Québec. Available at: http://publications.msss.gouv.qc.ca/msss/document-000105/.
Proulx, J. F., Déry, S., Jetté, L., Ismaël, J., Libman, M., & De Wals, P. (2002). Pneumonia epidemic caused by a virulent strain of Streptococcus pneumoniae serotype 1 in Nunavik, Quebec. Canada Communicable Disease Report, 28, 129–131.
Shapiro, E. D., Berg, A. T., Austrian, R., Schroeder, D., Parcells, V., Margolis, A., et al. (1991). The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. The New England Journal of Medicine, 325, 1453–1460. https://doi.org/10.1056/NEJM199111213252101.
Shigayeva, A., Rudnick, W., Green, K., Tyrrell, G., Demczuk, W. H., Gold, W. L., Gubbay, J., Jamieson, F., Plevneshi, A., Pong-Porter, S., Richardson, S., McGeer, A., & Toronto Invasive Bacterial Diseases Network. (2016). Association of serotype with respiratory presentations of pneumococcal infection, Ontario, Canada, 2003-2011. Vaccine, 34(6), 846–853.
Singleton, R. J., Butler, J. C., Bulkow, L. R., Hurlburt, D., O’Brien, K. L., Doan, W., et al. (2007). Invasive pneumococcal disease epidemiology and effectiveness of 23-valent pneumococcal polysaccharide vaccine in Alaska Native adults. Vaccine, 25, 2288–2295.
Tomczyk, S., Bennett, N. M., Stoecker, C., Gierke, R., Moore, M. R., Whitney, C. G., Hadler, S., & Pilishvili, T. (2014). Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Morbidity and Mortality Weekly Report, 63(37), 822–825 Available at: https://www.cdc.gov/mmwr/pdf/wk/mm6337.pdf.
Waight, P. A., Andrews, N. J., Ladhani, N. J., et al. (2015). Effect of the 13-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in England and Wales 4 years after its introduction: an observational cohort study. The Lancet Infectious Diseases, 15(6), 629.
Wenger, J., Zulz, T., Bruden, D., Singleton, R., Bruce, M. G., Bulkow, L., et al. (2010). Invasive pneumococcal disease in Alaskan children. The Pediatric Infectious Disease Journal, 29(3), 251–256.
Whitney, C. G., Pilishvili, T., Farley, M. M., Schaffner, W., Craig, A. S., Lynfield, R., et al. (2006). Effectiveness of seven-valent pneumococcal conjugate vaccine against invasive pneumococcal disease: a matched case-control study. Lancet, 368(9546), 1495–1502.
Acknowledgements
The authors thank all the health professionals in Nunavik who participated in the data collection.
Funding
The study was performed thanks to the financial support of the Quebec Ministry of Health and Social Services, GlaxoSmithKline, and Pfizer. Sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; and preparation of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Philippe De Wals received research grants, honoraria, and reimbursements of travel expenses from vaccine manufacturers, including GlaxoSmithKline, Novartis, Pfizer, and Sanofi Pasteur. The remaining authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
LeMeur, JB., Lefebvre, B., Proulx, JF. et al. Limited impact of pneumococcal vaccines on invasive pneumococcal disease in Nunavik (Quebec). Can J Public Health 110, 36–43 (2019). https://doi.org/10.17269/s41997-018-0138-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.17269/s41997-018-0138-2