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Volume 27, Number 7—July 2021

Whole-Genome Analysis of Streptococcus pneumoniae Serotype 4 Causing Outbreak of Invasive Pneumococcal Disease, Alberta, Canada

James D. KellnerComments to Author , Leah J. Ricketson, Walter H.B. Demczuk, Irene Martin, Gregory J. Tyrrell, Otto G. Vanderkooi, and Michael R. Mulvey
Author affiliations: University of Calgary, Calgary, Alberta, Canada (J.D. Kellner, L.J. Ricketson, O.G. Vanderkooi); Alberta Health Services, Calgary Zone, Calgary (J.D. Kellner, O.G. Vanderkooi); National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada (W.H.B. Demczuk, I. Martin, M.R. Mulvey); University of Alberta, Edmonton, Alberta (G.J. Tyrrell); Alberta Precision Laboratories–Public Health, Edmonton (G.J. Tyrrell)

Main Article

Table 1

Results of univariable tests of proportions of patient demographics and clinical characteristics of Streptococcus pneumoniae serotype 4 versus non–serotype 4 causing IPD, Calgary, Alberta, Canada, 2010–2018*

Characteristics Serotype 4, no. (%) Non–serotype 4, no. (%) % Difference (95% CI)
p value
Total cases, n = 990
Age ≥65 y 7 (7.5) 311 (34.9) 27.9 (22.0–33.8) <0.001
Homelessness 47 (47.5) 129 (14.8) 32.6 (22.5–42.8) <0.001
Illicit drug use 47 (58.0) 156 (22.5) 35.6 (24.4–46.8) <0.001
Alcohol abuse 50 (61.7) 238 (34.2) 27.5 (16.3–38.6) <0.001
Indigenous 13 (40.6) 105 (29.4) 11.2 (–6.4 to 28.9) 0.1862
Current or former smoker
85 (89.5)
579 (74.1)
15.3 (8.4–22.2)
Death ≤30 d 7 (7.0) 114 (12.9) 5.9 (0.5–11.4) 0.09†
Hospitalization 88 (88.0) 775 (88.1) 0.1 (–6.6 to 6.8) 0.9
ICU admission
29 (29.6)
224 (25.9)
3.7 (–5.8 to 13.2)
Underlying condition an indication for pneumococcal vaccination‡ (11) <0.001§
No underlying condition 46 (46.5) 279 (31.9) NA NA
Underlying condition, but immunocompetent 44 (44.4) 356 (40.7) NA NA
Underlying condition, immunocompromised
9 (9.1)
237 (27.4)
Primary diagnosis 0.02§
Bacteremia 1 (1.0) 89 (10.0) NA NA
Other IPD 1 (1.0) 38 (4.3) NA NA
Bacteremic pneumonia 82 (82.0) 613 (68.9) NA NA
Empyema 11 (11.0) 86 (9.7) NA NA
Pericarditis 7 (0.79) 1 (1.0) NA NA
Meningitis 4 (4.0) 56 (6.3) NA

*IPD, invasive pneumococcal disease; NA, not applicable †p value >0.05 but 95% CI does not cross 0, therefore significant. ‡Underlying conditions exclude alcohol and drug abuse. §p value from χ2 test; overall comparison made between groups but not for each level within groups because of multiple levels.

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