Abstract
Background
We conducted active surveillance for invasive pneumococcal disease to assess the serotype and antibiotic resistance patterns in Canada prior to universal infant immunization programs, in most provinces.
Methods
Active surveillance was conducted by the 12 centres of the Canadian Paediatric Society’s Immunization Monitoring Program, Active (IMPACT). This report includes children 16 years of age and younger with S. pneumoniae isolated from a normally sterile site, in 1998–2003.
Results
During six years of surveillance, 1,868 eligible cases were reported. The 7-valent pneumococcal conjugate vaccine (PCV7) matched 79% of isolates, including 84% from 6–23 month olds and 80% from 2–5 year olds. The proportion of isolates matched by PCV7 significantly decreased over the surveillance period from 81% in 1998 to 73% in 2003 (p=0.005). The 23-valent polysaccharide vaccine (PPS) matched 90% of isolates from children 2 years or older.
Results
Penicillin non-susceptibility rate was stable at 16% of isolates. Cefotaxime/ceftriaxone resistance rate was 5% and limited to penicillin-resistant isolates. Serotypes found in PCV7 accounted for 89% of penicillin-resistant isolates (100% including cross-reacting types 6A and 19A).
Conclusion
PCV7 matched three quarters of the isolates from young children as immunization programs began; therefore some program failures are inevitable. Children ≥5 years with predisposing conditions need the broader protection of 23-valent PPS vaccine and special attention from providers to ensure receipt. The rate of penicillin resistance remained steady over the last six years. The majority of isolates non-susceptible to penicillin are found in PCV7.
MeSH terms: Pneumococcal infections, drug resistance, pneumococcal vaccines
Résumé
Contexte
Nous avons effectué une surveillance active des maladies invasives à pneumocoques pour analyser les sérotypes et les structures d’antibiorésistance au Canada avant l’instauration des programmes de vaccination universelle des nourrissons dans la plupart des provinces.
Méthode
Une surveillance active a été effectuée par les 12 centres IMPACT (Programme canadien de surveillance active des effets secondaires associés aux vaccins) de la Société canadienne de pédiatrie. Notre article porte sur des enfants de 16 ans et moins atteints de la souche S. pneumoniae isolée sur un site normalement stérile entre 1998 et 2003.
Résultats
Durant les six années de surveillance, 1 868 cas admissibles ont été signalés. Les sérotypes du vaccin antipneumococcique conjugué heptavalent (VCP7) correspondaient à 79 % des isolats, dont 84 % chez les nourrissons de 6 à 23 mois et 80 % chez les enfants de 2 à 5 ans. La proportion d’isolats correspondant au VCP7 a sensiblement diminué au cours de la période de surveillance, passant de 81 % en 1998 à 73 % en 2003 (p=0,005). Les sérotypes du vaccin polysaccharidique 23-valent correspondaient à 90 % des isolats des enfants de 2 ans et plus. Le taux d’absence de sensibilité à la pénicilline (16 % des isolats) est resté stable. Le taux de résistance au céfotaxime/à la ceftriaxone (5 %) n’a été observé que dans les isolats résistants à la pénicilline. Les sérotypes contenus dans le VCP7 comptaient pour 89 % des isolats résistants à la pénicilline (100 % incluant les types récurrents 6A et 19A).
Conclusion
Les sérotypes du VCP7 ne couvraient que les trois quarts des isolats chez les jeunes enfants au début des programmes d’immunisation; certains échecs de la vaccination étaient donc inévitables. Les enfants de 5 ans et plus dont l’état de santé les prédispose aux infections ont besoin de la protection accrue du vaccin 23-valent, et les vaccinateurs doivent s’assurer que ce vaccin leur a été administré. Le taux de résistance à la pénicilline est resté stable au cours des six dernières années. La majorité des isolats non réceptifs à la pénicilline se trouvent dans le VCP7.
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