Severe bacterial infections that cause pneumonia and meningitis are on the rise in Alberta

Experts are keeping a close eye on the increase in invasive pneumococcal disease in Alberta.

The life-threatening disease is caused by bacteria called Streptococcus pneumoniae, which often appear after viral illnesses.

These bacteria—including 100 different variations—can live in the respiratory tract, often causing no symptoms. In their mild form, they can cause problems such as middle ear infections.

But when they invade normally germ-free parts of the body and become invasive, people develop pneumonia, meningitis, and sepsis.

Dr. Jim Kellner, an infectious disease specialist at the University of Calgary who studies invasive pneumococcal disease, said: “All age groups have seen an increase in cases and an increase in cases to the highest level I've ever seen.” Illness patterns in Calgary since 1998.

“It's troubling to see the kind of numbers we've seen. We expected to see big numbers last year. The consistent big numbers this year are a concern.”

Provincial data shows invasive pneumococcal cases rose last year from 481 in 2018 to 812, with declines in 2020 and 2021, which doctors attribute to pandemic-related restrictions.

This trend comes at the same time as the rate of invasive group A strep is increasing in Canada.

During these five years, hospitalizations for invasive pneumococcal disease increased from 398 to 681, and deaths from 42 to 62.

Per capita hospitalization and death rates are also on the rise, according to numbers from Alberta Health.

While the vast majority of serious cases reported last year were in adults, 44 of the 681 people hospitalized in 2023 were under the age of 18 and two children died.

“It's concerning when you see the number of infectious diseases increase,” said Dr. Sam Wong, a pediatrician at Edmonton's Stoller Children's Hospital and president of the Pediatrics Section of the Alberta Medical Association.

Wong has treated several children in the ICU in the past few weeks who needed chest tubes after pneumonia in which large amounts of fluid build up around the lungs.

“For a five-year-old to drain more than a liter of fluid, that's a huge volume. Then they're decompensated and they're intubated and need ventilation as well as blood pressure support.”

According to Kellner, the mortality rates for invasive pneumococcal disease in the Calgary area are as follows:

• children (under 18): 3 percent
• Adults over 18: 10%
• Seniors over 65: 15 percent
• Over 85: 25 percent

“Even though this is a disease that can be treated with antibiotics, in the most severe cases, in these invasive cases, you still have significant mortality,” he said.

Join the viral waves

According to Kellner, the causes of complications from invasive pneumococcal disease are complex.

Because pneumococcal disease often presents as a secondary infection, he has no doubt that recent viral waves play a key role.

Viral infections cause inflammation in the airways, he said, making it easier for bacteria to enter.

Secondary infections are often limited to the ears and sinuses. But bacteria can find their way into the bloodstream and travel to organs such as the lungs and brain.

“With the big jumps in RSV and flu last year, and this year being another big and early flu year, you would expect secondary bacterial infections to increase,” he said.

“This has had a huge impact on the growth and abundance of infections.”

Kellner said secondary pneumococcal infections can occur after COVID-19, but this is rare.

“It's a numbers game… When you have a high number of infections, rare complications are common,” Wong added.

“It's been pretty bad this year with the high number of flu cases we've seen.”

Pneumococcal vaccines are provided as part of routine childhood immunizations and are publicly funded for Albertans 65 and older.

Provincial data show a decline in immunization rates among children. In 2008, 90.5 percent of Alberta children were fully immunized with three doses of pneumococcal vaccine by age two. By 2022, this will drop to 80.8 percent.

Kellner said vaccines are evolving and new formulations have recently been approved for use in Canada.

“The growth we're seeing now is due to an increase in viral infections and pandemic factors that may disappear over time,” said Kellner, who has received funding from a number of companies over the past few decades. government grant agencies and pharmaceutical companies for research projects and vaccine clinical trials.

“It can be hoped that the new vaccines will have an effect in helping to ensure better control in the future. But we are a long way from truly controlling pneumococcal disease in the community, both locally and globally.”