Seroepidemiology of Invasive Pneumococcal Disease in Patients With Chronic Obstuctive Pulmonary Disease (COPD), Toronto, Canada
Bibliographic record
Abstract
Background. COPD is the 4th leading cause of death in the United States. Patients with COPD are one potential population for new pneumococcal vaccines. We reviewed population-based surveillance data in Toronto, Canada, to assess the burden of illness due to invasive pneumococcal disease (IPD) in persons with COPD. Methods. We report data from population-based surveillance for IPD in Toronto/Peel region since 1995. Cases are reported to a central study laboratory; antibiotic susceptibility and serotyping are performed. Patient information is collected by interview and chart review. Vaccine efficacy (VE) was estimated by the indirect cohort method. Results. A total of 1269/8641 (14.7%) adults IPD cases had underlying COPD. The average annual incidence of IPD in COPD patients from 2004 to 2015 was 6.0/100,000 for those aged 15–49 years, 12.7/100,000 for those aged 50–64 years, and 27.5/100,000 in those aged 65+. Median age was 74 years (range 31–103 years; 72% age ≥ 65). Among cases with available data, 620/859 (72%) had received influenza vaccine in the previous fall, 398/832 (48%) had received pneumococcal polysaccharide vaccine (PPSV), and 359/937 (38%) were current smokers. There were1073 cases of pneumonia (33 with empyema), 113 primary bacteremia, 21 meningitis, 54 other diagnoses. Four hundred eighteen (33%) required ICU admission, (28%) died during the hospitalization. The median length of stay (LOS) was 9 days (mean 19, IQR 4–19). VE for PPSV was 32% (95% CL 5%–50%). The case fatality decreased over time (205/666, 31% 1995–2005 versus 145/454 2006–2015, P < .001), ICU admission increased (199/660, 3% versus 219/602, 36%, P = .02) and LOS did not change. Incidence over time by serotype category is shown in Figure 1: herd immunity has substantially reduced disease due to PCV7 serotypes. The distribution of serotypes is different in patients with and without underlying COPD (Figure 2). In 2014/15, in patients with COPD, serotypes included in PCV7 caused 5.3% of disease, compared to 37.8% caused by additional PCV13 serotype, 22% by PPSV/non-PCV serotypes, and 35% by non-vaccine types. Conclusion. Despite the benefits of PPV23 in individual adults, herd immunity associated with pediatric PCV programs and declining case fatality, IPD burden in COPD patients is substantial. Use of PCV13, and new vaccines are needed to reduce this burden. Disclosures. A. McGeer, Pfizer Canada: Grant Investigator and Scientific Advisor, Grant recipient
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".