National laboratory surveillance of Invasive streptococcal disease in Canada - Annual summary 2018
Executive summary
- Streptococcus pneumoniae: 3,279 isolates causing invasive pneumococcal disease (IPD) were characterized in 2018.
- Incidence rate of IPD declined in children under <1 year of age to 11.9 cases per 100,000 population and increased in seniors ≥60 years to 23.4 cases per 100,000 population compared to 2017. The overall crude incidence rate has remained stable averaging 9.6 cases per 100,000 population since 2009.
- PCV7 serotypes decreased slightly in 2018 from 2017 in most age groups accounting for 10% of IPD, except for the 5–14 year olds which increased by 3%.
- PCV13 (not including PCV7) serotypes accounted for 21% of overall IPD, showing a slight increase from 2017 levels. Rates of serotype 3 increased in all age groups except infants where numbers are very low (n=3 for 2018).
- Overall proportions of PPV23 have increased slightly, by 2%, in the last five years and non-vaccine serotypes (NVT) have decreased by 3.5% in the same time frame.
- Predominant serotypes in 2018 were 3 (12%), 22F (9%), 4 (6%), 9N (6%) and 8 (6%).
- Antimicrobial susceptibility: Testing of 1,792 isolates indicated levels of resistance were again relatively stable during 2018 with the following resistance rates: clarithromycin (26%), penicillin (11%), doxycycline (8%), trimethoprim/sulfamethoxazole (8%), clindamycin (7%), chloramphenicol (6%), meropenem (2%), and imipenem (1%). Serotypes 6A/C, 19A/F, 23A/F, 15A, 9V, 14 and 35B generally had the highest rates of antimicrobial resistance. Multi-drug resistance decreased from 10% in 2017 to 8% in 2018. The highest rates of multi-drug resistance were seen in serotypes 15A (57%) and 19A (30%).
- S. pyogenes (Group A Streptococcus): 3,202 isolates causing invasive disease were characterized for emm type.
- Overall, the annual incidence rate of invasive disease has increased from 4.0 to 7.9 cases per 100,000 population from 2009 to 2018.
- emm1 continues to be the most predominant type among all combined age groups and regions (17%) (Figure C). Regional increases of emm6 in the East (15%) and emm76 (13%) and emm74 (16%) in the West have been noted.
- Antimicrobial susceptibility: Antimicrobial resistance of S. pyogenes is relatively low, decreases were seen in 2018 with chloramphenicol non-susceptibility at 2.6% and clindamycin resistance at 3.5%. Erythromycin resistance remained constant at 10%.
- S. agalactiae (Group B Streptococcus): There were 290 invasive Group B Streptococcus submitted to NML during 2018, of which 7 isolates were from early onset cases (infants ≤7 days old) and 8 were from late onset cases (infants 8 – 31 days old). Annual incidence of invasive disease in newborns has fluctuated from a low of 25.0 per 100,000 live births in 2009 to a high of 38.1 in 2016; the incidence rate in 2018 was 24.7.
- Serotypes V (25%), III (17%) and Ib and IV (16% each) were most predominant.
- Antimicrobial susceptibility: Resistance of S. agalactiae to erythromycin decreased to 42% while clindamycin resistance decreased to 31%.
Figure A. Invasive S. pneumoniae serotypes in all ages
* Component of PCV7; ** Component of PCV13; ^ Component of PPV23; ‡ Number of isolates for 2014, 2015, 2016, 2017 and 2018 respectively.
Figure A - Text description
Bar graph displaying the percentage of Streptococcus pneumonia serotypes from 2014 to 2018 based on the total number of isolates tested annually.
| Column Labels | 2014 (n=2564) | 2015 (n=2689) | 2016 (n=2808) | 2017 (n=3223) | 2018 (n=3279) |
|---|---|---|---|---|---|
| 4* (57,103,182,234,205)‡ | 2.2% | 3.8% | 6.5% | 7.3% | 6.3% |
| 6B* (5,10,20,9,8) | 0.2% | 0.4% | 0.7% | 0.3% | 0.2% |
| 9V* (9,7,5,15,35) | 0.4% | 0.3% | 0.2% | 0.5% | 1.1% |
| 14* (12,12,16,29,13) | 0.5% | 0.4% | 0.6% | 0.9% | 0.4% |
| 18C* (6,6,9,8,4) | 0.2% | 0.2% | 0.3% | 0.2% | 0.1% |
| 19F* (25,47,46,90,74) | 1.0% | 1.7% | 1.6% | 2.8% | 2.3% |
| 23F* (10,8,4,2,2) | 0.4% | 0.3% | 0.1% | 0.1% | 0.1% |
| 1** (3,4,4,0,0) | 0.1% | 0.1% | 0.1% | 0.0% | 0.0% |
| 3** (223,235,267,309,390) | 8.7% | 8.7% | 9.5% | 9.6% | 11.9% |
| 5** (0,3,0,0,0) | 0.0% | 0.1% | 0.0% | 0.0% | 0.0% |
| 6A** (17,9,19,7,14) | 0.7% | 0.3% | 0.7% | 0.2% | 0.4% |
| 7F** (184,145,109,115,106) | 7.2% | 5.4% | 3.9% | 3.6% | 3.2% |
| 19A** (221,213,176,159,175) | 8.6% | 7.9% | 6.3% | 4.9% | 5.3% |
| 2^ (0,0,0,1,2) | 0.0% | 0.0% | 0.0% | 0.0% | 0.1% |
| 8^ (105,139,148,156,186) | 4.1% | 5.2% | 5.3% | 4.8% | 5.7% |
| 9N^ (109,115,138,213,188) | 4.3% | 4.3% | 4.9% | 6.6% | 5.7% |
| 10A^ (60,47,48,64,62) | 2.3% | 1.7% | 1.7% | 2.0% | 1.9% |
| 11A^ (117,97,91,93,117) | 4.6% | 3.6% | 3.2% | 2.9% | 3.6% |
| 12F^ (88,128,102,126,160) | 3.4% | 4.8% | 3.6% | 3.9% | 4.9% |
| 15B/C^(83,87,126,123,103) | 3.2% | 3.2% | 4.5% | 3.8% | 3.1% |
| 17F^ (32,22,29,37,37) | 1.2% | 0.8% | 1.0% | 1.1% | 1.1% |
| 20^ (70,90,81,117,127) | 2.7% | 3.3% | 2.9% | 3.6% | 3.9% |
| 22F^ (282,252,255,280,285) | 11.0% | 9.4% | 9.1% | 8.7% | 8.7% |
| 33F^ (59,89,98,105,94) | 2.3% | 3.3% | 3.5% | 3.3% | 2.9% |
| 6C (91,78,73,66,58) | 3.5% | 2.9% | 2.6% | 2.0% | 1.8% |
| 6D (2,3,0,0,0) | 0.1% | 0.1% | 0.0% | 0.0% | 0.0% |
| 7A (0,1,0,0,0) | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
| 7B (1,2,0,2,0) | 0.0% | 0.1% | 0.0% | 0.1% | 0.0% |
| 7C (20,30,43,28,57) | 0.8% | 1.1% | 1.5% | 0.9% | 1.7% |
| 9A (0,2,0,0,1) | 0.0% | 0.1% | 0.0% | 0.0% | 0.0% |
| 9L (0,0,2,3,2) | 0.0% | 0.0% | 0.1% | 0.1% | 0.1% |
| 10B (4,2,2,2,3) | 0.2% | 0.1% | 0.1% | 0.1% | 0.1% |
| 10F (1,0,2,3,2) | 0.0% | 0.0% | 0.1% | 0.1% | 0.1% |
| 11B (2,6,3,0,0) | 0.1% | 0.2% | 0.1% | 0.0% | 0.0% |
| 11C (0,0,0,0,1) | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
| 11D (0,0,0,3,0) | 0.0% | 0.0% | 0.0% | 0.1% | 0.0% |
| 12A (0,0,0,0,4) | 0.0% | 0.0% | 0.0% | 0.0% | 0.1% |
| 12B (0,0,0,1,0) | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
| 13 (12,7,9,6,10) | 0.5% | 0.3% | 0.3% | 0.2% | 0.3% |
| 15A (111,119,123,152,128) | 4.3% | 4.4% | 4.4% | 4.7% | 3.9% |
| 16F (96,73,72,77,70) | 3.7% | 2.7% | 2.6% | 2.4% | 2.1% |
| 17A (0,1,0,0,0) | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
| 18A (1,0,1,0,0) | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
| 18F (0,0,1,0,2) | 0.0% | 0.0% | 0.0% | 0.0% | 0.1% |
| 21 (6,14,12,20,15) | 0.2% | 0.5% | 0.4% | 0.6% | 0.5% |
| 22A (4,1,0,1,0) | 0.2% | 0.0% | 0.0% | 0.0% | 0.0% |
| 23A (108,110,107,152,112) | 4.2% | 4.1% | 3.8% | 4.7% | 3.4% |
| 23B (85,85,83,101,116) | 3.3% | 3.2% | 3.0% | 3.1% | 3.5% |
| 24 (1,2,1,0,1) | 0.0% | 0.1% | 0.0% | 0.0% | 0.0% |
| 24A (0,0,1,0,1) | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
| 24B (1,2,1,1,2) | 0.0% | 0.1% | 0.0% | 0.0% | 0.1% |
| 24F (14,20,23,27,23) | 0.5% | 0.7% | 0.8% | 0.8% | 0.7% |
| 25A (0,0,0,0,1) | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
| 25F (1,0,0,0,0) | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
| 27 (0,0,0,0,1) | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
| 28A (1,3,5,10,10) | 0.0% | 0.1% | 0.2% | 0.3% | 0.3% |
| 29 (13,15,10,4,6) | 0.5% | 0.6% | 0.4% | 0.1% | 0.2% |
| 31 (40,36,50,51,54) | 1.6% | 1.3% | 1.8% | 1.6% | 1.6% |
| 32A (0,0,0,2,0) | 0.0% | 0.0% | 0.0% | 0.1% | 0.0% |
| 33A (3,10,4,2,0) | 0.1% | 0.4% | 0.1% | 0.1% | 0.0% |
| 33B (0,0,1,0,0) | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
| 33C (0,0,0,1,0) | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
| 34 (22,27,30,28,33) | 0.9% | 1.0% | 1.1% | 0.9% | 1.0% |
| 35A (2,1,4,2,0) | 0.1% | 0.0% | 0.1% | 0.1% | 0.0% |
| 35B (51,61,62,78,74) | 2.0% | 2.3% | 2.2% | 2.4% | 2.3% |
| 35C (1,1,0,0,0) | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
| 35F (60,64,56,50,44) | 2.3% | 2.4% | 2.0% | 1.6% | 1.3% |
| 37 (4,2,2,2,1) | 0.2% | 0.1% | 0.1% | 0.1% | 0.0% |
| 38 (21,37,46,51,51) | 0.8% | 1.4% | 1.6% | 1.6% | 1.6% |
| 42 (0,0,0,1,0) | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
| NT (8,6,6,4,9) | 0.3% | 0.2% | 0.2% | 0.1% | 0.3% |
Figure B. Annual trend of multi-drug resistance of S. pneumoniae
* Antimicrobial classes include: β-lactams (amoxicillin/clavulanic acid, penicillin using meninigitis breakpoints, ceftriaxone using meningitis breakpoints, cefuroxime using parenteral breakpoint, ertapenem, imipenem and meropenem); macrolides (clarithromycin); fluoroquinolones (levofloxacin and moxifloxacin); tetracyclines (doxycycline); folate pathway inhibitors (trimethoprim-sulfamethoxazole); phenicols (chloramphenicol); lincosamides (clindamycin); oxazolidinones (linezolid).
Figure B - Text description
A combination line and stacked bar graph displaying multidrug resistance trends from 2014 to 2018 for Streptococcus pneumoniae
| Category 1 | Resistant to 7 classes* | Resistant to 6 classes | Resistant to 5 classes | Resistant to 4 classes | Resistant to 3 classes | Resistant to 2 classes | Resistant to 1 class | Resistant to ≥3 classes |
|---|---|---|---|---|---|---|---|---|
| 2014 (n=1116) | 0.0% | 0.5% | 1.0% | 1.5% | 2.0% | 8.3% | 18.3% | 5.0% |
| 2015 (n=1128) | 0.0% | 0.0% | 1.8% | 2.6% | 2.4% | 5.2% | 18.4% | 6.7% |
| 2016 (n=1114) | 0.0% | 0.1% | 0.8% | 2.8% | 2.5% | 6.4% | 18.2% | 6.2% |
| 2017 (n=1129) | 0.0% | 0.4% | 1.5% | 4.6% | 3.1% | 6.1% | 19.5% | 9.6% |
| 2018 (n=1792) | 0.0% | 0.9% | 2.1% | 2.2% | 2.4% | 6.1% | 22.1% | 7.6% |
Figure C. Invasive S. pyogenes emm types
† Number of isolates from 2014, 2015, 2016, 2017 and 2018, respectively.
Figure C - Text description
Bar graph displaying emm types of Streptococcus pyogenes from 2014 to 2018 by percentage based on the total number of isolates tested annually.
| Column1 | 2014 (n=1704) | 2015 (n=1760) | 2016 (n=2154) | 2017 (n=2473) | 2018 (n=3202) |
|---|---|---|---|---|---|
| 1 (456,317,323,449,547)† | 26.8% | 18.0% | 15.0% | 18.2% | 17.1% |
| 2 (46,39,31,33,53) | 2.7% | 2.2% | 1.4% | 1.3% | 1.7% |
| 3 (37,150,132,61,88) | 2.2% | 8.5% | 6.1% | 2.5% | 2.7% |
| 4 (99,86,98,86,100) | 5.8% | 4.9% | 4.5% | 3.5% | 3.1% |
| 5 (9,8,11,7,11) | 0.5% | 0.5% | 0.5% | 0.3% | 0.3% |
| 6 (80,41,57,48,109) | 4.7% | 2.3% | 2.6% | 1.9% | 3.4% |
| 8 (2,0,1,0,2) | 0.1% | 0.0% | 0.0% | 0.0% | 0.1% |
| 9 (10,11,11,41,45) | 0.6% | 0.6% | 0.5% | 1.7% | 1.4% |
| 11 (55,85,64,68,72) | 3.2% | 4.8% | 3.0% | 2.7% | 2.2% |
| 12 (108,128,137,147,145) | 6.3% | 7.3% | 6.4% | 5.9% | 4.5% |
| 13 (0,0,0,0,3) | 0.0% | 0.0% | 0.0% | 0.0% | 0.1% |
| 18 (0,0,5,4,3) | 0.0% | 0.0% | 0.2% | 0.2% | 0.1% |
| 22 (18,26,25,25,30) | 1.1% | 1.5% | 1.2% | 1.0% | 0.9% |
| 25 (1,2,3,1,4) | 0.1% | 0.1% | 0.1% | 0.0% | 0.1% |
| 28 (107,92,97,126,164) | 6.3% | 5.2% | 4.5% | 5.1% | 5.1% |
| 33 (1,0,0,0,3) | 0.1% | 0.0% | 0.0% | 0.0% | 0.1% |
| 41 (36,44,37,55,47) | 2.1% | 2.5% | 1.7% | 2.2% | 1.5% |
| 44 (6,3,4,4,9) | 0.4% | 0.2% | 0.2% | 0.2% | 0.3% |
| 48 (1,3,5,4,3) | 0.1% | 0.2% | 0.2% | 0.2% | 0.1% |
| 49 (1,3,12,70,99) | 0.1% | 0.2% | 0.6% | 2.8% | 3.1% |
| 53 (45,57,26,37,131) | 2.6% | 3.2% | 1.2% | 1.5% | 4.1% |
| 58 (3,9,22,14,10) | 0.2% | 0.5% | 1.0% | 0.6% | 0.3% |
| 59 (31,24,49,57,35) | 1.8% | 1.4% | 2.3% | 2.3% | 1.1% |
| 63 (1,0,1,2,5) | 0.1% | 0.0% | 0.0% | 0.1% | 0.2% |
| 64 (0,0,0,1,3) | 0.0% | 0.0% | 0.0% | 0.0% | 0.1% |
| 68 (43,31,40,25,24) | 2.5% | 1.8% | 1.9% | 1.0% | 0.7% |
| 73 (10,9,8,15,7) | 0.6% | 0.5% | 0.4% | 0.6% | 0.2% |
| 74 (0,9,172,234,372) | 0.0% | 0.5% | 8.0% | 9.5% | 11.6% |
| 75 (21,23,33,41,60) | 1.2% | 1.3% | 1.5% | 1.7% | 1.9% |
| 76 (10,9,8,73,205) | 0.6% | 0.5% | 0.4% | 3.0% | 6.4% |
| 77 (18,36,36,33,64) | 1.1% | 2.0% | 1.7% | 1.3% | 2.0% |
| 78 (0,0,0,0,3) | 0.0% | 0.0% | 0.0% | 0.0% | 0.1% |
| 80 (33,26,22,9,9) | 1.9% | 1.5% | 1.0% | 0.4% | 0.3% |
| 81 (30,113,160,226,200) | 1.8% | 6.4% | 7.4% | 9.1% | 6.2% |
| 82 (23,60,104,63,68) | 1.3% | 3.4% | 4.8% | 2.5% | 2.1% |
| 83 (19,24,32,37,57) | 1.1% | 1.4% | 1.5% | 1.5% | 1.8% |
| 87 (37,29,37,29,40) | 2.2% | 1.6% | 1.7% | 1.2% | 1.2% |
| 89 (159,112,107,136,144) | 9.3% | 6.4% | 5.0% | 5.5% | 4.5% |
| 90 (1,2,0,2,3) | 0.1% | 0.1% | 0.0% | 0.1% | 0.1% |
| 91 (15,25,38,34,27) | 0.9% | 1.4% | 1.8% | 1.4% | 0.8% |
| 92 (4,2,3,14,63) | 0.2% | 0.1% | 0.1% | 0.6% | 2.0% |
| 93 (1,1,3,4,2) | 0.1% | 0.1% | 0.1% | 0.2% | 0.1% |
| 94 (4,4,7,5,11) | 0.2% | 0.2% | 0.3% | 0.2% | 0.3% |
| 101 (52,42,110,87,50) | 3.1% | 2.4% | 5.1% | 3.5% | 1.6% |
| 102 (1,7,5,8,8) | 0.1% | 0.4% | 0.2% | 0.3% | 0.2% |
| 103 (0,2,0,0,2) | 0.0% | 0.1% | 0.0% | 0.0% | 0.1% |
| 110 (0,0,2,1,3) | 0.0% | 0.0% | 0.1% | 0.0% | 0.1% |
| 112 (0,2,0,2,2) | 0.0% | 0.1% | 0.0% | 0.1% | 0.1% |
| 114 (11,14,17,8,19) | 0.6% | 0.8% | 0.8% | 0.3% | 0.6% |
| 118 (25,23,29,8,15) | 1.5% | 1.3% | 1.3% | 0.3% | 0.5% |
| 168 (0,0,0,0,4) | 0.0% | 0.0% | 0.0% | 0.0% | 0.1% |
| 169 (1,1,2,9,4) | 0.1% | 0.1% | 0.1% | 0.4% | 0.1% |
| Other (33,26,28,30,15) | 1.9% | 1.5% | 1.3% | 1.2% | 0.5% |