背景:侵袭性肺炎球菌病(IPD)负担,在加拿大使用监测系统中报告的确诊病例进行评估,由于漏报,可能被低估了。我们通过将监测数据与卫生管理数据库相结合,估计了安大略省和不列颠哥伦比亚省(BC)的IPD负担。
方法:我们在安大略省和不列颠哥伦比亚省建立了一个由27,525名个体组成的队列。实验室确认的IPD病例是从安大略省的综合公共卫生信息系统和BC疾病控制中心公共卫生实验室确定的。从两个省份的住院数据中确定了可能的IPD病例,以及安大略省急诊科的访视数据。我们使用泊松回归模型估计了年龄和性别调整后的IPD和肺炎球菌结合物/多糖疫苗(PCV/PPV)血清型特异性IPD的年发病率。
结果:在安大略省,总共20205例IPD病例,包括15299例实验室确诊病例,经年龄和性别调整后的年发病率相对稳定,范围为13.7/100,000(2005年)至13.6/100,000(2018年)。在BC,总共7320例IPD病例,确定了5,932例实验室确诊病例;年发病率从10.9/100,000(2002)增加到13.2/100,000(2018).年龄≥85岁的老年人发病率最高。在2007-2018年期间,两个省份的PCV7血清型和其他PCV13血清型的发病率下降,而独特的PPV23和非疫苗血清型的发病率增加。
结论:尽管有公共资助的肺炎球菌疫苗接种计划,IPD仍然在加拿大造成巨大的公共卫生负担,部分原因是独特的PPV23和非疫苗血清型增加。
BACKGROUND: Invasive pneumococcal disease (IPD) burden, evaluated in Canada using reported confirmed cases in surveillance systems, is likely underestimated due to underreporting. We estimated the burden of IPD in Ontario and British Columbia (BC) by combining surveillance data with health administrative databases.
METHODS: We established a cohort of 27,525 individuals in Ontario and BC. Laboratory-confirmed IPD cases were identified from Ontario\'s integrated Public Health Information System and the BC Centre for Disease Control Public Health Laboratory. Possible IPD cases were identified from hospitalization data in both provinces, and from emergency department visit data in Ontario. We estimated the age and sex adjusted annual incidence of IPD and pneumococcal conjugate/polysaccharide vaccine (PCV/PPV) serotype-specific IPD using Poisson regression models.
RESULTS: In Ontario, 20,205 overall IPD cases, including 15,299 laboratory-confirmed cases, were identified with relatively stable age- and sex-adjusted annual incidence rates ranging from 13.7/100,000 (2005) to 13.6/100,000 (2018). In BC, 7,320 overall IPD cases, including 5,932 laboratory-confirmed cases were identified; annual incidence rates increased from 10.9/100,000 (2002) to 13.2/100,000 (2018). Older adults aged ≥ 85 years had the highest incidence rates. During 2007-2018 the incidence of PCV7 serotypes and additional PCV13 serotypes decreased while the incidence of unique
PPV23 and non-vaccine serotypes increased in both provinces.
CONCLUSIONS: IPD continues to cause a substantial public health burden in Canada despite publicly funded pneumococcal vaccination programs, resulting in part from an increase in unique
PPV23 and non-vaccine serotypes.