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
Clinical Research Funding:
• Wyeth
Consultations (Advisory Boards)/Presentations:
• Wyeth, GSK
Credit: PneumoACTION 2010 website.
PneumoACTION is a project of the International Vaccine Access Center
at Johns Hopkins Bloomberg School of Public Health
Pneumococcus
Polysaccharide Capsule
Streptococcus pneumoniae
Capsule major virulence factor
91 different capsule types (serotypes).
1
2
3
4
5
6A
6B
6C
7A
7B
7C
7F
8
9A
9L
9N
9V
10A
10B
10C
10F
11A
11B
11C
11D
11F
12A
12B
12F
13
14
15A
15B
15C
15F
16A
16F
17A
17F
18A
18B
18C
18F
19A
19B
19C
19F
20
21
22A
22F
23A
23B
23F
24A
24B
24F
25A
25F
27
28A
28F
29
31
32A
32F
33A
33B
33C
33D
33F
34
35A
35B
35C
35F
36
37
38
39
40
41
41F
42
43
44
45
46
47A
47F
48
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
Source: Clinical updates in Pediatric Infectious Diseases. Vol2(6): Feb 1999.
Incidence / 100,000 in < 2 year age group
INCIDENCE OF IPD IN ALBERTA CHILDREN 0-23 MO.
2000 –2007
100
86.26 / 100,000
PCV7
nonPCV7
80
60
40
20
1.1 / 100,000
0
2000
2001
2002
Tyrrell 2009. Vaccine. 27(27):3553-3560.
2003
2004
2005
2006
2007
2008
IPD CASES IN CANADA: ISOLATE SUBMISSION
NUMBERS BY CASE. 2000 –2009
2400
2200
Number of Cases
2000
1800
1600
1400
1200
1000
800
600
400
200
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
NUMBER OF ISOLATES SEROTYPED BY NCS
2000-2009 CANADA (EXCLUDING QUEBEC)
900
800
Number of Cases
700
600
500
400
300
200
100
0
0
10
20
30
40
50
Age
60
70
80
90
100
NUMBER OF CASES BY
PROVINCE OR TERRITORY
2000-2009 13,896 CASES
NUMBER OF CASES BY
PROVINCE OR TERRITORY
2008 AND 2009
4500
750
700
650
600
Number of Cases
3500
3000
2500
2000
1500
2008
2009
550
500
450
400
350
300
250
200
1000
150
100
500
50
Province of Territory
U
N
W
T
N
YK
S
PE
I
N
FL
D
N
B
N
O
N
B
M
B
C
SK
A
B
U
N
W
T
YK
Province of Territory
N
S
B
PE
I
N
FL
D
N
N
O
N
B
M
B
A
SK
0
C
0
B
Number of Cases
4000
ALL CASES COUNTED WERE FROM INVASIVE
DISEASE ONLY.
Non-invasive cases excluded.
Ears, eyes, throats, urine, respiratory not counted.
PNEUMOCOCCI SEROTYPED –
CANADA (EXCLUDING QUEBEC)
0-23 MONTHS
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
Extra serotypes provided by PHiD10 and PCV13 only.
55
1 (10 & 13)
3 (13)
5 (10 & 13)
6A (13)
7F (10 & 13)
19A (13)
50
Number of Cases
45
40
35
30
25
20
15
10
5
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
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
55
Number of Cases
50
*
PCV7
PHiD10
PCV13
NVT
* PPV23
45
40
35
30
25
20
15
*
10
5
0
* *
* * *
4
6B
9V
*
*
*
* * *
14 18C 19F 23F
1
5
7F
3
6A 19A 22F 38
Serotype
* * *
*
*
33F 17F 12F 10A 15A 35F 11A 16F
PNEUMOCOCCI SEROTYPES IN
WESTERN CANADA 0-23 MONTHS
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
January 2009 to February 2010
30
28
Number of Cases
*
PCV7
PHiD10
PCV13
NVT
* PPV23
26
24
22
20
18
16
14
12
10
8
*
6
4
2
0
* * * * *
4
6B
9V
*
*
*
* *
14 18C 19F 23F
1
5
*
7F
3
6A 19A 22F 38
Serotype
*
* * *
*
33F 17F 12F 10A 15A 35F 11A 16F
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
PNEUMOCOCCI SEROTYPES IN
ONTARIO 0-23 MONTHS
January 2009 to February 2010
24
22
PCV7
PHiD10
PCV13
NVT
* PPV23
Number of Cases
20
18
16
14
*
12
10
8
6
* *
4
0
*
*
2
* * * *
4
6B
9V
* * * *
14 18C 19F 23F
1
5
* *
*
7F
3
6A 19A 22F 38
Serotype
*
*
33F 17F 12F 10A 15A 35F 11A 16F
PNEUMOCOCCI SEROTYPES IN
CANADA (EXCLUDING QUEBEC)
2-4 YEARS January 2009 to February 2010
*
28
26
PCV7
PHiD10
PCV13
NVT
* PPV23
24
Number of Cases
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
22
20
18
16
14
12
10
*
8
6
*
4
2
0
*
*
*
*
* *
*
* *
4
1
6B
9V
14 18C 19F 23F
5
7F
3
*
6A 19A 23B 15B 15A 15C 10A 35B
Serotype
* * *
9N 33F 12F 35A
PNEUMOCOCCI SEROTYPES IN
WESTERN CANADA 2-4 YEARS
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
January 2009 to February 2010
Number of Cases
16
15
PCV7
PHiD10
PCV13
NVT
* PPV23
14
13
12
11
10
9
8
7
*
6
5
4
3
2
1
0
*
* * * * *
4
6B
9V
*
*
*
* * *
14 18C 19F 23F
1
5
7F
3
*
6A 19A 23B 15B 15A 15C 10A 35B
Serotype
*
*
*
9N 33F 12F 35A
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
PNEUMOCOCCI SEROTYPES IN
ONTARIO 2-4 YEARS
January 2009 to February 2010
Number of Cases
16
15
14
*
PCV7
PHiD10
PCV13
NVT
* PPV23
13
12
11
10
9
8
7
6
5
4
3
2
1
0
* *
*
4
*
6B
*
9V
*
14
* *
18C 19F
*
* * *
23F
1
5
7F
3
*
6A 19A 23B 15B 15A 15C 10A 35B
Serotype
*
9N
*
*
33F 12F 35A
Number of Cases
PNEUMOCOCCI SEROTYPES IN
CANADA (EXCLUDING QUEBEC)
5-19 YEARS January 2009 to February 2010
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
PCV7
PHiD10
PCV13
NVT
* PPV23
*
*
*
*
*
*
*
*
4
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
*
*
*
*
*
6B 9V 14 18C 19F 23F
* * *
*
1
5
7F
3
6A 19A 22F 23B 33F 23A 15A 15B 17F 12F 35F
Serotype
*
8
21 15C
PNEUMOCOCCI SEROTYPES IN
WESTERN CANADA 5-19 YEARS
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
Number of Cases
January 2009 to February 2010
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
PCV7
PHiD10
PCV13
NVT
* PPV23
*
*
*
*
*
*
6B
9V
14
C
18
*
*
* *
4
*
*
F
F
19 23
1
*
*
5
7F
3
* *
*
6A 19A
F
F
F
F
F
B
A
A
B
22 23 33 23 15 15 17 12 35
Serotype
*
8
21
C
15
PNEUMOCOCCI SEROTYPES IN
ONTARIO 5-19 YEARS
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
Number of Cases
January 2009 to February 2010
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
PCV7
PHiD10
PCV13
NVT
* PPV23
*
*
* *
4
*
*
*
* * *
*
* * *
6B 9V 14 18C 19F 23F
1
5
7F
3
*
* *
6A 19A 22F 23B 33F 23A 15A 15B 17F 12F 35F
Serotype
*
8
21 15C
PNEUMOCOCCI SEROTYPES IN
CANADA (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
140
130
Number of Cases
*
PCV7
PHiD10
PCV13
NVT
* PPV23
120
110
100
90
80
*
*
70
* *
60
50
*
* *
* *
40
*
30
20
* * * * * *
*
10
0
4
6B
9V
14 18C 19F 23F
1
5
7F
3
6A 19A 22F
Serotype
8
* *
12F 33F 9N 11A 10A 20 16F 23A
PNEUMOCOCCI SEROTYPES IN
WESTERN CANADA 20-64 YEARS
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
January 2009 to February 2010
75
70
Number of Cases
*
PCV7
PHiD10
PCV13
NVT
* PPV23
65
60
55
50
45
40
*
35
30
25
* *
*
*
*
* * * *
20
15
10
* *
* * * * * * *
5
0
4
6B
9V
14 18C 19F 23F
1
5
7F
3
6A 19A 22F
Serotype
8
12F 33F
9N 11A 10A 20
16F 23A
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
PNEUMOCOCCI SEROTYPES IN
ONTARIO 20-64 YEARS
January 2009 to February 2010
75
70
PCV7
PHiD10
PCV13
NVT
* PPV23
Number of Cases
65
60
55
50
45
40
*
*
35
30
25
20
15
*
*
*
10
* * * *
5
0
4
6B
9V
*
* *
* * *
* * *
14 18C 19F 23F
1
5
7F
3
6A 19A 22F
Serotype
8
12F 33F
* *
9N 11A 10A 20
16F 23A
Number of Cases
PNEUMOCOCCI SEROTYPES IN
CANADA (EXCLUDING QUEBEC)
65+ YEARS January 2009 to February 2010
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
*
PCV7
PHiD10
PCV13
NVT
* PPV23
*
*
*
*
*
* *
4
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
6B
9V
* *
* *
* *
14 18C 19F 23F
*1 *5
7F
3
* *
6A 19A 22F 11A 23A 9N 33F 16F 15B
Serotype
8
15A 35B
PNEUMOCOCCI SEROTYPES IN
WESTERN CANADA 65+ YEARS
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
January 2009 to February 2010
50
PCV7
PHiD10
PCV13
NVT
* PPV23
Number of Cases
45
40
35
30
*
*
25
*
20
*
15
*
10
5
*
* *
0
4
6B
9V
* *
* *
* *
* *
14 18C 19F 23F
1
5
7F
3
* *
6A 19A 22F 11A 23A 9N 33F 16F 15B
Serotype
8
15A 35B
PNEUMOCOCCI SEROTYPES IN
ONTARIO 65+ YEARS
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
January 2009 to February 2010
50
PCV7
PHiD10
PCV13
NVT
* PPV23
Number of Cases
45
40
35
30
*
*
*
*
25
20
15
10
*
*
5
* *
* *
* *
0
4
6B
9V
* *
14 18C 19F 23F
*
* *
1
5
7F
3
6A 19A 22F 11A 23A 9N 33F 16F 15B
Serotype
8
15A 35B
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
A
pr
0
A 0
ug
0
D 0
ec
0
A 0
pr
0
A 1
ug
0
D 1
ec
0
A 1
pr
0
A 2
ug
0
D 2
ec
0
A 2
pr
0
A 3
ug
0
D 3
ec
0
A 3
pr
0
A 4
ug
0
D 4
ec
0
A 4
pr
0
A 5
ug
0
D 5
ec
0
A 5
pr
0
A 6
ug
0
D 6
ec
0
A 6
pr
0
A 7
ug
0
D 7
ec
0
A 7
pr
0
A 8
ug
0
D 8
ec
0
A 8
pr
0
A 9
ug
09
No. of cases
SEROTYPE 5 OUTBREAK IN WESTERN CANADA
ON
NT
SK
MB
BC
AB
Date of collection of S. pneumonaie isolate
SEROTYPE 5 CASES BY AGE
45
40
unknown
female
male
35
No. of cases
30
25
20
15
10
5
0
0
10
20
30
40
50
60
Age of case in years
70
80
90
100
CANADA 2009
PCV7
PHiD10
PCV13
Percent coverage
Based on invasive pneumococcal isolates
submitted to the NCS for serotyping.
serotype
0-23 mo
2-4 yrs
5-19 yrs
20-64 yrs
65+ yrs
4
2
5
6
49
21
6B
1
3
0
13
13
9V
0
1
3
13
11
14
0
2
4
12
7
18C
1
4
10
11
5
19F
4
13
5
15
14
23F
0
2
0
9
15
1
0
0
1
3
0
5
3
1
5
34
3
7F
13
17
13
113
58
3
7
22
5
95
71
6A
2
6
8
31
53
19A
51
68
16
147
92
84/137
144/213
76/109
545/985
363/655
PCV7
5.8%
14.1%
25.7%
12.4%
13.1%
PHiD10
17.5%
22.5%
43.1%
27.6%
22.4%
PCV13
61.3%
67.6%
69.7%
55.3%
55.4%
WESTERN CANADA 2009 (BC, AB, SK, MN)
PCV7
PHiD10
PCV13
Percent coverage
Based on invasive pneumococcal isolates
submitted to the NCS for serotyping.
serotype
0-23 mo
2-4 yrs
5-19 yrs
20-64 yrs
65+ yrs
4
1
0
5
27
7
6B
1
0
0
7
5
9V
0
0
2
6
3
14
0
0
2
7
1
18C
0
0
6
8
0
19F
2
1
3
5
5
23F
0
0
0
7
6
1
0
0
1
4
0
5
3
0
5
31
2
7F
7
2
6
41
18
3
1
5
1
47
34
6A
2
3
5
10
18
19A
27
11
5
66
34
44/74
22/30
41/60
266/527
133/262
PCV7
5.4%
3.3%
30.0%
12.7%
10.3%
PHiD10
18.9%
10.0%
50.0%
27.1%
17.9%
PCV13
59.5%
73.3%
68.3%
50.5%
50.8%
ONTARIO 2009
PCV7
PHiD10
PCV13
Percent coverage
Based on invasive pneumococcal isolates
submitted to the NCS for serotyping.
serotype
0-23 mo
2-4 yrs
5-19 yrs
20-64 yrs
65+ yrs
4
1
4
0
16
9
6B
0
2
0
5
6
9V
0
1
1
6
8
14
0
1
2
2
3
18C
0
3
2
3
4
19F
2
0
2
7
7
23F
0
0
0
2
7
1
0
0
0
0
0
5
0
0
0
0
0
7F
5
9
6
59
36
3
5
13
3
35
27
6A
0
2
2
19
30
19A
21
40
11
60
50
34/53
75/103
29/42
208/340
187/324
PCV7
5.7%
10.7%
16.7%
12.1%
13.5%
PHiD10
15.1%
19.4%
30.9%
29.4%
24.7%
PCV13
64.2%
72.8%
69.0%
63.0%
57.7%
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
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.