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Large community outbreak of Streptococcus pneumoniae serotype 5 invasive infection in an impoverished, urban
Marc G Romney1, Mark W Hull, Réka Gustafson
1Department of Pathology, Laboratory Medicine, St Paul's Hospital, Providence Health Care, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. mromney@providencehealth.bc.ca
Background:
Streptococcus pneumoniae is a common cause of sporadic invasive infections, but outbreaks of invasive pneumococcal disease are infrequent. In August 2006, a sudden increase in the number of patients presenting with invasive pneumococcal disease was noted at St. Paul's Hospital (Vancouver, Canada). Most patients with severe disease resided in an area referred to as the Downtown Eastside, a neighborhood known for its high rates of poverty and illicit drug use.
Methods:
Prospective, laboratory-based surveillance for invasive pneumococcal disease was initiated, including on-site serotyping of S. pneumoniae isolates. A vaccination campaign using 23-valent polysaccharide pneumococcal vaccine was launched in the Downtown Eastside. Multiple logistic regression was used to examine the association of sociodemographic variables and medical risk factors with S. pneumoniae serotype status.
Results:
A single S. pneumoniae serotype (serotype 5) was responsible for 78% of invasive pneumococcal disease cases (137 of 175 cases) during the outbreak period of August 2006-July 2007. The outbreak strain, although fully susceptible to penicillin, caused significant morbidity and placed considerable strain on the acute care system within the Vancouver Coastal Health region. Crack cocaine use was found to be the main independent risk factor associated with invasive pneumococcal disease due to S. pneumoniae serotype 5 (odds ratio, 12.4; 95% confidence interval, 2.22-69.5).
Conclusions:
A targeted vaccination campaign using polysaccharide pneumococcal vaccine appeared to help control this outbreak. In urban centers with high rates of illicit drug use, vaccination strategies for preventing invasive pneumococcal disease may need to be refined to include individuals who use crack cocaine.
Insights
An invasive pneumococcal disease outbreak in Vancouver was linked to Streptococcus pneumoniae serotype 5. Crack cocaine use emerged as a significant risk factor, prompting a need to refine vaccination strategies for vulnerable populations.
Area of Science:
- Infectious Disease Epidemiology
- Public Health Surveillance
- Bacteriology
Background:
- Invasive pneumococcal disease (IPD) outbreaks are rare, but a surge was observed in Vancouver in 2006.
- Affected patients, particularly those with severe illness, were concentrated in the Downtown Eastside, an area with high poverty and drug use.
- This highlighted a potential link between socioeconomic factors and IPD incidence.
Purpose of the Study:
- To investigate the cause and risk factors of an unusual increase in invasive pneumococcal disease cases.
- To identify the specific Streptococcus pneumoniae serotype responsible for the outbreak.
- To evaluate the effectiveness of public health interventions, including vaccination.
Main Methods:
- Prospective, laboratory-based surveillance for IPD was conducted.
- On-site serotyping of Streptococcus pneumoniae isolates was performed.
- Logistic regression analysis was used to identify sociodemographic and medical risk factors associated with IPD.
Main Results:
- Streptococcus pneumoniae serotype 5 was identified as the predominant cause, accounting for 78% of cases during the outbreak.
- Crack cocaine use was significantly associated with IPD caused by serotype 5 (OR=12.4).
- The outbreak strain was susceptible to penicillin but caused substantial morbidity and healthcare system strain.
Conclusions:
- A targeted vaccination campaign with 23-valent polysaccharide pneumococcal vaccine appeared to contribute to outbreak control.
- Vaccination strategies in urban areas with high illicit drug use should consider including crack cocaine users.
- Refined public health approaches are necessary to prevent IPD in at-risk urban populations.
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