April 20, 2001

Invasive Meningococcal Disease (IMD): Canada
Invasive meningococcal disease appears to be on the rise in Canada. Since January 1, 2001, there have been 129 cases of IMD reported to Health Canada (115 laboratory confirmed and 14 clinical), of which 74 cases (57%) are confirmed as serogroup C. A total of 13 cases (10%) have died, including seven cases (9%) with serogroup C disease. At least 43 (58%) of the serogroup C cases have been associated with six clusters/outbreaks across Canada occurring in localities in Quebec (two), Ontario (one), Manitoba (one), Alberta (one) and British Columbia (one). Targeted vaccination programs for specific age groups (mostly for people between the ages of 10 and 29 years) have been announced in the six localities with clusters/outbreaks. The crude rate of IMD in Canada is 0.43 cases per 100,000 population (annualized rate is 1.64 cases per 100,000 population). For the same time period for the years 1996 to 2000, between 59 and 93 cases of IMD were reported. Meninogococcal disease tends to occur in 10 to 15 year cycles of high and low incidence. The peak of the last cycle of high incidence occurred in 1992. Special precautions are not currently necessary for travellers to Canada. The risk of serogroup C IMD for visitors to Canada, even in areas with elevated activity, is extremely low and vaccination is not generally indicated. Persons moving to become a resident or to attend educational institutions in an area with elevated IMD activity should contact the local health authority to be considered for the local vaccination program if one is in place.
Source: The Division of Respiratory Diseases, Centre for Infectious Disease Prevention and Control, Health Canada

Pneumococcal Disease: United States
A 23-valent polysaccharide pneumococcal vaccine has been available for older children and adults, and a protein-polysaccharide pneumococcal 7-valent conjugate vaccine was recently licensed for use in young children. 1995-1998 data from the Active Bacterial Core Surveillance system was analyzed to assess the burden of pneumococcal disease in the United States and estimate the impact of these new vaccines. Invasive infection with Streptococcus pneumoniae was estimated to cause more than 62,000 cases and more than 6,000 deaths in 1998. Incidence of pneumococcal disease was highest among children < 2 years and adults aged 65 years or older and was more than 2 times higher among blacks than whites. Most of the strains isolated from cases in the high-risk age groups were included in the indicated vaccines.
Source: Journal of the American Medical Association, Vol 285, No 13, April 4, 2001

Pneumococcal and Influenza Vaccines: Sweden
Elderly people in Sweden vaccinated against influenza and pneumococcal disease have fewer hospital admissions and lower all-cause mortality. The study cohort consisted of all the population of Stockholm County in Sweden aged 65 years or older (259,627/1,783,440), who were invited (over an 8 week period in 1998) to receive (at reduced cost) vaccines against influenza and pneumococcal infection. Thirty-nine per cent of the target population (100,242) were vaccinated : 76,177 against both infections; 23, 224 against influenza only, and 841 against pneumococcal infection only. The incidence of admission to hospital over the next 6 months among those who had been vaccinated was significantly lower for all endpoint diagnoses: 46% lower for influenza with or without pneumonia, 29% for pneumonia, 36% lower for pneumococcal pneumonia, and 52% lower for invasive pneumococcal disease. Vaccination more than halved the death rate. The cohort is to be followed up for 3 years.
Source: Eurosurveillance Weekly, Issue 14, April 5, 2001 (primary reference: The Lancet, Vol 357, No 9261 March 31, 2001)

The details given are for information only and may be very provisional. Where incidents are considered of national importance and are ongoing, the initial report will be updated as new information becomes available.