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PNEUMOCOCCAL SEROTYPES - WHAT’S HAPPENING ACROSS CANADA? Focus on 2009 Gregory J. Tyrrell, PhD, FCCM, D(ABMM) Division of Medical Microbiology Department of Laboratory Medicine and Pathology Public Health Laboratory - Alberta University of Alberta. CONFLICT OF INTEREST DISCLOSURE STATEMENT

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slide1

PNEUMOCOCCAL SEROTYPES - WHAT’S HAPPENING ACROSS CANADA?

Focus on 2009

Gregory J. Tyrrell, PhD, FCCM, D(ABMM)

Division of Medical Microbiology

Department of Laboratory Medicine and Pathology

Public Health Laboratory - Alberta

University of Alberta

slide2

CONFLICT OF INTEREST DISCLOSURE STATEMENT

  • Clinical Research Funding:
  • Wyeth
  • Consultations (Advisory Boards)/Presentations:
  • Wyeth, GSK
slide3

Credit: PneumoACTION 2010 website.

PneumoACTION is a project of the International Vaccine Access Centerat Johns Hopkins Bloomberg School of Public Health

slide4

Pneumococcus

Polysaccharide Capsule

slide5

Streptococcus pneumoniae

Capsule major virulence factor

91 different capsule types (serotypes).

1 10F 18B 28A 40 PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

2 11A 18C 28F 41 PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

3 11B 18F 29 41F PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

4 11C 19A 31 42

5 11D 19B 32A 43

6A 11F 19C 32F 44

6B 12A 19F 33A 45

6C 12B 20 33B 46

7A 12F 21 33C 47A

7B 13 22A 33D 47F

7C 14 22F 33F 48

7F 15A 23A 34

8 15B 23B 35A

9A 15C 23F 35B

9L 15F 24A 35C

9N 16A 24B 35F

9V 16F 24F 36

10A 17A 25A 37

10B 17F 25F 38

10C 18A 27 39

slide7

PCV7

nonPCV7

INCIDENCE OF IPD IN ALBERTA CHILDREN 0-23 MO.

2000 –2007

86.26 / 100,000

Incidence / 100,000 in < 2 year age group

1.1 / 100,000

Tyrrell 2009. Vaccine. 27(27):3553-3560.

slide8

IPD CASES IN CANADA: ISOLATE SUBMISSION

NUMBERS BY CASE. 2000 –2009

Number of Cases

slide9

NUMBER OF ISOLATES SEROTYPED BY NCS

2000-2009 CANADA (EXCLUDING QUEBEC)

Number of Cases

Age

slide10

NUMBER OF CASES BY PROVINCE OR TERRITORY

2000-2009 13,896 CASES

NUMBER OF CASES BY PROVINCE OR TERRITORY

2008 AND 2009

2008

2009

Number of Cases

Number of Cases

Province of Territory

Province of Territory

slide11

ALL CASES COUNTED WERE FROM INVASIVEDISEASE ONLY.

Non-invasive cases excluded.

Ears, eyes, throats, urine, respiratory not counted.

slide12

PNEUMOCOCCI SEROTYPED –

CANADA (EXCLUDING QUEBEC)

0-23 MONTHS Extra serotypes provided by PHiD10 and PCV13 only.

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

1 (10 & 13)

3 (13)

5 (10 & 13)

6A (13)

7F (10 & 13)

19A (13)

Number of Cases

slide13

PNEUMOCOCCI SEROTYPES IN

CANADA (EXCLUDING QUEBEC)

0-23 MONTHS January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

*

PCV7

PHiD10

PCV13

NVT

* PPV23

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide14

PNEUMOCOCCI SEROTYPES IN

WESTERN CANADA 0-23 MONTHS

January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

*

PCV7

PHiD10

PCV13

NVT

* PPV23

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide15

PNEUMOCOCCI SEROTYPES IN

ONTARIO 0-23 MONTHS

January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

PCV7

PHiD10

PCV13

NVT

* PPV23

*

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide16

PNEUMOCOCCI SEROTYPES IN

CANADA (EXCLUDING QUEBEC)

2-4 YEARS January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

*

PCV7

PHiD10

PCV13

NVT

* PPV23

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide17

PNEUMOCOCCI SEROTYPES IN

WESTERN CANADA 2-4 YEARS

January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

PCV7

PHiD10

PCV13

NVT

* PPV23

*

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide18

PNEUMOCOCCI SEROTYPES IN

ONTARIO 2-4 YEARS

January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

*

PCV7

PHiD10

PCV13

NVT

* PPV23

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide19

PNEUMOCOCCI SEROTYPES INCANADA (EXCLUDING QUEBEC)5-19 YEARS January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

*

PCV7

PHiD10

PCV13

NVT

* PPV23

*

*

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide20

PNEUMOCOCCI SEROTYPES IN

WESTERN CANADA 5-19 YEARS

January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

PCV7

PHiD10

PCV13

NVT

* PPV23

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide21

PNEUMOCOCCI SEROTYPES IN

ONTARIO 5-19 YEARS

January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

PCV7

PHiD10

PCV13

NVT

* PPV23

*

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide22

PNEUMOCOCCI SEROTYPES INCANADA (EXCLUDING QUEBEC)20-64 YEARS January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

*

PCV7

PHiD10

PCV13

NVT

* PPV23

*

*

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide23

PNEUMOCOCCI SEROTYPES IN

WESTERN CANADA 20-64 YEARS

January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

*

PCV7

PHiD10

PCV13

NVT

* PPV23

*

*

*

*

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide24

PNEUMOCOCCI SEROTYPES IN

ONTARIO 20-64 YEARS

January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

PCV7

PHiD10

PCV13

NVT

* PPV23

*

*

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide25

PNEUMOCOCCI SEROTYPES INCANADA (EXCLUDING QUEBEC)65+ YEARS January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

*

PCV7

PHiD10

PCV13

NVT

* PPV23

*

*

*

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide26

PNEUMOCOCCI SEROTYPES IN

WESTERN CANADA 65+ YEARS

January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

PCV7

PHiD10

PCV13

NVT

* PPV23

*

*

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide27

PNEUMOCOCCI SEROTYPES IN

ONTARIO 65+ YEARS

January 2009 to February 2010

PCV7: 4, 6B, 9V, 14, 18C, 19F, 23F

PHiD10: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F

PCV13: 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F,3,6A, 19A

PCV7

PHiD10

PCV13

NVT

* PPV23

*

*

*

Number of Cases

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Serotype

slide30

CANADA 2009

PCV7

PHiD10

PCV13

Percent coverage

Based on invasive pneumococcal isolates

submitted to the NCS for serotyping.

slide31

WESTERN CANADA 2009 (BC, AB, SK, MN)

PCV7

PHiD10

PCV13

Percent coverage

Based on invasive pneumococcal isolates

submitted to the NCS for serotyping.

slide32

ONTARIO 2009

PCV7

PHiD10

PCV13

Percent coverage

Based on invasive pneumococcal isolates

submitted to the NCS for serotyping.

slide33

SUMMARY

1. Pneumococcal capsule main virulence factor

2. 91 different capsule types (serotypes)

3. 3 conjugate vaccines (7-valent, 10-valent, 13-valent)

4. Serotyping at NCS has doubled in the last couple of years

5. PCV7 introduced in Canada 2002

6. PCV7 cases have dropped in the 0-4 years group since this time

7. 19A has increased in the 0-23 month age group in Canada

8. 7F next in this age category

9. PCV13 coverage in Canada based on serotype of isolates submitted to the National Centre for Streptococcus:

0-23 = 61.3%

2-4 = 67.6%

5-19 = 69.7%

20-64 = 55.3%

65+ = 55.4%

10. Large serotype 5 outbreak in Western Canada

slide34

ACKNOWLEDGEMENTS

Members of the National Centre for Streptococcus involved in pneumococcal serotyping:

Marg Lovgren

Jocelyne Kakulphimp

Donna Hurteau

Karen Beyent

Connie Tsang

Also like to thank the Provincial Laboratories and Diagnostic Laboratories who

submitted invasive pneumococcal isolates for serotyping.

Continued support from Alberta Health and Wellness, the National Microbiology Laboratory and Wyeth.

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