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PNEUMOCOCCAL SEROTYPES - WHAT’S HAPPENING ACROSS CANADA? Focus on 2009 Gregory J. Tyrrell, PhD, FCCM, D(ABMM) Division o

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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PNEUMOCOCCAL SEROTYPES - WHAT’S HAPPENING ACROSS CANADA? Focus on 2009 Gregory J. Tyrrell, PhD, FCCM, D(ABMM) Division o

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  1. 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

  2. CONFLICT OF INTEREST DISCLOSURE STATEMENT • Clinical Research Funding: • Wyeth • Consultations (Advisory Boards)/Presentations: • Wyeth, GSK

  3. Credit: PneumoACTION 2010 website. PneumoACTION is a project of the International Vaccine Access Centerat Johns Hopkins Bloomberg School of Public Health

  4. Pneumococcus Polysaccharide Capsule

  5. 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

  6. Source: Clinical updates in Pediatric Infectious Diseases. Vol2(6): Feb 1999.

  7. 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.

  8. IPD CASES IN CANADA: ISOLATE SUBMISSION NUMBERS BY CASE. 2000 –2009 Number of Cases

  9. NUMBER OF ISOLATES SEROTYPED BY NCS 2000-2009 CANADA (EXCLUDING QUEBEC) Number of Cases Age

  10. 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

  11. ALL CASES COUNTED WERE FROM INVASIVEDISEASE ONLY. Non-invasive cases excluded. Ears, eyes, throats, urine, respiratory not counted.

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

  27. 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

  28. SEROTYPE 5 OUTBREAK IN WESTERN CANADA

  29. SEROTYPE 5 CASES BY AGE

  30. CANADA 2009 PCV7 PHiD10 PCV13 Percent coverage Based on invasive pneumococcal isolates submitted to the NCS for serotyping.

  31. WESTERN CANADA 2009 (BC, AB, SK, MN) PCV7 PHiD10 PCV13 Percent coverage Based on invasive pneumococcal isolates submitted to the NCS for serotyping.

  32. ONTARIO 2009 PCV7 PHiD10 PCV13 Percent coverage Based on invasive pneumococcal isolates submitted to the NCS for serotyping.

  33. 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

  34. 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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