title: The epidemiology of invasive pneumococcal disease in older adults from 2007 to 2014 in Ontario, Canada: a population-based study.
abstract: BACKGROUND
  In Ontario, pneumococcal conjugate vaccines (PCVs) have been sequentially introduced into the publicly funded childhood vaccination program since 2005. A 23-valent polysaccharide pneumococcal vaccine (PPV23) has been routinely recommended for adults aged 65 years and older since 1996. To determine the effect of herd immunity, we examined the epidemiology of invasive pneumococcal disease in adults aged 65 years and older.
  
  
  METHODS
  Invasive pneumococcal disease is a provincially reportable disease. We were therefore able to conduct a descriptive epidemiologic analysis that included assessing time trends for patients aged 65 years and older using surveillance data from 2007 to 2014. Using serotype information within the surveillance data, cases were grouped into categories according to vaccine type and periods and then compared using Poisson regression.
  
  
  RESULTS
  A total of 3825 cases of invasive pneumococcal disease were reported among adults aged 65 years and older, for an overall annualized incidence of 25.4 cases per 100 000 population. There was a decrease in incidence due to serotypes included in 7-valent PCV (3.0 to 0.7 cases per 100 000 population) (p< 0.001). For 13-valent PCV serotypes, there was a decrease in incidence between 2011 and 2014 (9.8 to 5.3 cases per 100 000 population (p< 0.001)). Serotypes unique to PPV23 and those not included in a vaccine increased from 2.3 to 5.8 and from 2.4 to 7.2 cases per 100 000 population, respectively (p< 0.001).
  
  
  CONCLUSIONS
  In older adults, among serotypes contained in PCVs, we have shown a decrease in incidence of invasive pneumococcal disease. This is likely due to herd immunity from the childhood program. A burden of illness due to unique PPV23 serotypes and those that are not covered by a vaccine exists and has increased over time.
authors.affiliation: Immunization and Vaccine Preventable Diseases Division (Desai, Policarpio, Wong, Fediurek, Deeks), Public Health Ontario; Public Health Ontario Laboratories (Gubbay), Public Health Ontario; Department of Laboratory Medicine and Pathobiology (Gubbay) and Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont.
authors.forename: Shalini
authors.initials: S
authors.lastname: Desai
authors.affiliation: Immunization and Vaccine Preventable Diseases Division (Desai, Policarpio, Wong, Fediurek, Deeks), Public Health Ontario; Public Health Ontario Laboratories (Gubbay), Public Health Ontario; Department of Laboratory Medicine and Pathobiology (Gubbay) and Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont.
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Policarpio
authors.affiliation: Immunization and Vaccine Preventable Diseases Division (Desai, Policarpio, Wong, Fediurek, Deeks), Public Health Ontario; Public Health Ontario Laboratories (Gubbay), Public Health Ontario; Department of Laboratory Medicine and Pathobiology (Gubbay) and Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont.
authors.forename: Kenney
authors.initials: K
authors.lastname: Wong
authors.affiliation: Immunization and Vaccine Preventable Diseases Division (Desai, Policarpio, Wong, Fediurek, Deeks), Public Health Ontario; Public Health Ontario Laboratories (Gubbay), Public Health Ontario; Department of Laboratory Medicine and Pathobiology (Gubbay) and Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gubbay
authors.affiliation: Immunization and Vaccine Preventable Diseases Division (Desai, Policarpio, Wong, Fediurek, Deeks), Public Health Ontario; Public Health Ontario Laboratories (Gubbay), Public Health Ontario; Department of Laboratory Medicine and Pathobiology (Gubbay) and Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont.
authors.forename: Jill
authors.initials: J
authors.lastname: Fediurek
authors.affiliation: Immunization and Vaccine Preventable Diseases Division (Desai, Policarpio, Wong, Fediurek, Deeks), Public Health Ontario; Public Health Ontario Laboratories (Gubbay), Public Health Ontario; Department of Laboratory Medicine and Pathobiology (Gubbay) and Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont.
authors.forename: Shelley
authors.initials: S
authors.lastname: Deeks