Influenza, Pneumonia, Killing Manitoba's Aboriginals

STREPTOCOCCUS PNEUMONIAE, INVASIVE DISEASE - CANADA: (MANITOBA)
REQUEST FOR INFORMATION
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International Society for Infectious Diseases


Date: Tue 1 Feb 2011
Source: chrisd.ca/blog [edited]



An outbreak of invasive pneumococcal disease is making its way
through the city's downtown and Point Douglas areas, the Winnipeg
Regional Health Authority [WRHA] warned on Tuesday [1 Feb 2011]. The
threat of the disease is severe enough for the WRHA to begin
organizing mass immunization clinics to protect those who are most vulnerable.

Winnipeg saw 98 cases of the disease in 2010, compared to an average
of 55 annually in the previous 3 years. The WRHA says the elderly,
homeless and those with chronic illness are most at risk.

"This is a very serious, potentially fatal illness," Dr. Carol
Kurbis, a Medical Officer of Health with the WRHA, said. "It's
important we vaccinate as many members of the at-risk population as possible."

Clinics in the area will be available throughout February and into
March [2011]. Public Health Nurses will visit shelters, soup kitchens
and select housing complexes in the area for those at high risk and
provide the vaccine at no cost to anyone who wants it and fits the
following criteria: Anyone who is homeless; Anyone with a chronic
illness, such as a weakened immune system; kidney, heart or lung
disease; diabetes; Anyone who suffers from an addiction (to illicit
drugs or alcohol); Anyone 65 years or older; and Anyone living in a
long term care facility. A full list of conditions can be found on
the province's website.

Those who meet the criteria can also visit their family doctor of
community health clinic to receive the vaccination.

The pneumococcal vaccine prevents pneumococcal infections, which can
cause serious and sometimes deadly illness, including infections in
the lung (pneumonia), blood (bacteremia), and brain (meningitis).
There are more than 90 different types of pneumococcal bacteria. The
pneumococcal polysaccharide vaccine protects against the 23 types
that cause most of the severe pneumococcal infections. The
vaccination is generally only given once in a lifetime, except to
individuals at highest risk.

--
Communicated by:
ProMED-mail


[The news release above reports on an outbreak of invasive
pneumococcal disease (IPD) in the downtown and Point Douglas areas of
Winnipeg, capital of the Canadian province of Manitoba. IPD is a term
for used for pneumococcal disease when pneumococci are isolated from
cultures of normally sterile body fluids: for example, blood,
cerebrospinal fluid, and pleural fluid. IPD thus includes primary
pneumococcal bacteremia (i.e., blood cultures positive for
pneumococci when no source is identified), pneumonia complicated by
pneumococcal bacteremia, empyema (positive pleural fluid cultures),
and meningitis (positive cerebrospinal fluid cultures).

However, in the absence of cultures of normally sterile fluids that
are positive for pneumococci, pneumococcal pneumonia is not included
in the definition of IPD because of diagnostic uncertainty. Most
patients with pneumococcal pneumonia will not have normally sterile
fluids (e.g., blood, cerebrospinal fluid, or pleural fluid) that grow
pneumococci. Thus, this definition of IPD underestimates the
frequency of severe pneumococcal disease in the community.

Although the news release does not mention of ethnic make-up of the
cases of IPD, we are told that IPD is occurring among the homeless in
Winnipeg's downtown and Point Douglas areas. It has been estimated
that 72% of the homeless men are Aboriginals in some Winnipeg
neighborhoods
()
and that one 3rd of the population in Winnipeg's Point Douglas
neighborhood is Aboriginal
(), compared with just 8
per cent in the whole of Winnipeg
().

Also, although the above news release does not mention if these cases
of IPD were a complication of influenza, influenza A activity has
recently been reported by ProMED-mail in the aboriginal population of
Manitoba. Influenza can predispose to secondary bacterial pneumonia,
a cause of substantial illness and death in pandemic and seasonal
influenza. _Streptococcus pneumonia_ is a common cause of bacterial
pneumonia that follows influenza A infection.

Also, we are not told if the isolates of pneumococci were serotyped.
ProMED-mail reported that Canada was having a problem with
multidrug-resistant _Streptococcus pneumonia_ serotype 19A (see
ProMED-mail Strep. pneumoniae, serotypes 5, 19A - Canada: (BC, ON)
20071111.3666). This serotype is included in the pneumococcal
polysaccharide vaccine that covers 23 serotypes (PPV23) and the new
pneumococcal conjugate vaccine that covers 13 serotypes (PCV13), but
not PCV that covers 7 serotypes (PCV7).

Winnipeg is located in southern Manitoba and is its largest city,
with more than 60% of Manitoba's population
(). The HealthMap/ProMED-mail
interactive map of Canada, showing the location of the province of
Manitoba, can be accessed at:
. - Mod.ML]

[see also:
2010
----
Influenza (17): Canada (MB), 1st nation 20101203.4341
2007
----
Strep. pneumoniae, serotypes 5, 19A - Canada: (BC, ON), cor 20071114.3695
Strep. pneumoniae, serotypes 5, 19A - Canada: (BC, ON) 20071111.3666
Strep. pneumoniae, non-vaccine strain emergence - USA (02): (MA) 20071022.3437
Strep. pneumoniae, non-vaccine strain emergence - USA (AK) 20070425.1348
2006
----
Streptococcus pneumoniae, serotypes 5,8 - Canada (AB) 20061214.3520
Streptococcus pneumoniae, serotype 5 - Canada (BC) (02) 20061212.3502
Streptococcus pneumoniae, serotype 5 - Canada (BC) 20061209.3477
1999
----
Drug resistance, Pneumococcus - Canada (02) 19990904.1550
Pneumococcal meningitis, Japan: RFI 19990329.0499
1998
----
Antibiotic resistance, pneumococcal - South Africa & USA 19980428.0823
1997
----
Strep. pneumoniae, drug resistant - Canada (Ontario) 19970503.0904]
...................ml/ejp/dk

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