1. Ontario’s Pneumococcal Vaccination Program Allison McGeer

2. Adult pneumococcal vaccination - expert opinion
Public health experts uniformly recommend vaccine (NACI, ACIP)
Clinician experts tend not to (eg. CTFPHE)
Ontario mounts population-based pneumococcal vaccination program

3. Prevention of pneumococcal disease in adults
NACI recommends vaccine for:
all those >65 years of age
all persons with asplenia, splenic dysfunction or sickle cell disease
all persons with: chronic cardiorespiratory disease (except asthma), cirrhosis, alcoholism, chronic renal disease, nephrotic syndrome diabetes mellitus, chronic CSF leak, HIV infection and other conditions associated with immunosuppression

4. Provincial pneumococcal vaccine program - primary strategies
Deliver pneumococcal vaccine with influenza vaccine
Target 70% of NACI eligible persons
Supply vaccine over three years; withhold enough stock for mid-year use

5. Implementation Focus groups
Mailing to all physicians describing program
Q&A on program, vaccine
articles (rationale, repeat vaccination, combined vaccine)
Press Conference for launch
Notification with influenza vaccine order that 30% as many doses of pneumococcal vaccine would be supplied

6. Hypothesis:
The Ontario pneumococcal vaccination program will reduce the rate of invasive pneumococcal disease in the vaccine-eligible population

7. Anticipated impact of Ontario vaccination program

8. Outcome evaluation
Telephone surveys of vaccine eligible population to determine vaccination rates
Assessment of disease incidence:
comparison of disease incidence by age, and in vaccine eligible and non-eligible groups
comparison of disease incidence with Quebec
indirect cohort analysis of vaccine efficacy
time series analysis

9. LSPQ surveillance Jan 1, 1996 -
Lab-based reporting of number of sterile site pneumococcal isolates from all labs in of Quebec
Sentinel laboratories (N=20-25) send isolates for serotyping, susceptibility testing

10. Vaccine Coverage (pre-program)
Community Surveys:
Duclos (1994) 1.8% >65 yrs (Canada)
Hockin (1996) 7.4% eligibles (Ottawa)
MD survey: 8% of GPs recommended vaccine to eligible patients
1994: 40% LTCF residents vaccinated

11. Vaccine Distributed and Estimated Coverage - Ontario

12. Pneumococcal vaccination rates, by risk group

13. Rate of invasive pneumococcal disease, by age group, metropolitan Toronto/Peel region

14. Cases of invasive disease by vaccine eligibility, Metro/Peel, 1995-8

15. Rate of invasive pneumococcal disease: Metro/Peel vs. Quebec

16. Total rates of invasive pneumococcal disease in Metropolitan Toronto and Quebec population (per 100,000 populations),

17. Indirect cohort analysis

18. Rates of invasive pneumococcal disease in vaccine eligible population (per 100,000 population) Metropolitan Toronto/Peel Region,

19. Rate of invasive pneumococcal disease in vaccine ineligible populations (per 100,000 populations) Metropolitan Toronto/Peel Region,

20. Anticipated/observed impact of Ontario Vaccination Program

21. Conclusions
Ontario program increased pneumococcal vaccination rates, largely in the >65 yr group
New program will be needed for further increases
The increase was associated with a significant reduction in the incidence of invasive disease

22. Next Questions Vaccine efficacy in subgroups
Defining additional risk groups (smokers, cancer)
Duration of immunity
Impact on pneumonia

23. Microbiology technologists, infection control
TIBDN
Wigdan Al-Sukhni (U of T)
Patricia Avarino (Ryerson)
Lynda Eunson
Ellie Goldenberg
Karen Green
Lisa Landry
Margaret McArthur
Sharon Miller
Andrew Morris (U of T)
Agron Plevneshi
Sylvia Pong-Porter
Nilofar Siddiqi
Liljana Trpeski
Barbara Willey
Microbiology technologists, infection control
practitioners, public health inspectors from metropolitan Toronto/Peel region

24. TIBDN 2003/2004 NEW: sterile site Salmonella spp.
S. pneumoniae - sterile sites and respiratory
Clinical isolates of MRSA
Group B streptococci
Group A streptococci
NEW: sterile site Salmonella spp.