Pneumococcal disease, invasive

Reporting Obligations

Individuals with suspect or confirmed cases must be reported by the next working day to the Thunder Bay District Health Unit by fax, phone or mail.

• Fax: 807-625-4822
• Phone: 807-625-8318 or toll-free at 1-888-294-6630, ext. 8318 
• Mail: 999 Balmoral Street, Thunder Bay, ON P7B 6E7

Please use the Reportable Disease Notification Form.

Epidemiology

TBDHU 

• IPD increase: TBDHU has seen an increase of invasive pneumococcal disease (IPD) in the TBDHU area.
• Compared to provincial rates: As of September 2026, the TBDHU rates were 5 times higher than the provincial rates.

Provincial

• Public Health Ontario (PHO) monthly provincial updates -  Infectious Diseases at a Glance

Vaccine Recommendations

Routine Programs

65 years and older:

• Pneu-C-21 for those aged 65 years and older
  • Pneu-C-21 has replaced Pneu-P-20 for older adults 65 and older
• See the  Ministry of Health Fact Sheet for the updated guidance for adults 18 and older

 6 weeks to 4 years: 

• Pneu-C-15 for children 6 weeks to 4 years of age at low-risk for IPD
• See the Ministry of Health Fact Sheet for the updated guidance for children 6 weeks to 17 years

High-Risk Eligibility

6 weeks and older who have certain medical or non-medical conditions that increase their risk of invasive pneumococcal disease (IPD)

• Pneu-C-20 is given to those with certain medical or non-medical conditions that increase their risk of invasive pneumococcal disease (IPD)
• See the list below

High-Risk Eligibility Criteria for those 6 weeks and older

1. Asplenia (functional or anatomic), splenic dysfunction 

2. Congenital (primary) immunodeficiencies involving any part of the immune system, including B-lymphocyte (humoral) immunity, T-lymphocyte (cell) mediated immunity, complement system (properdin, or factor D deficiencies), or phagocytic functions 

3. HIV infection 

4. Immunocompromising therapy including use of long-term systemic corticosteroid, chemotherapy, radiation therapy, post-organ transplant therapy, certain antirheumatic drugs and other immunosuppressive therapy 

5. Malignant neoplasms, including leukemia and lymphoma 

6. Sickle-cell disease and other sickle cell hemoglobinopathies 

7. Solid organ or islet cell transplant (recipient) 

8. Hepatic cirrhosis due to any cause 

9. Chronic renal disease, including nephrotic syndrome 

10. Chronic cardiac disease 11. Chronic liver disease, including hepatitis B and C 

12. Chronic respiratory disease, excluding asthma, except those treated with highdose corticosteroid therapy 

13. Chronic neurologic conditions that may impair clearance of oral secretions 

14. Diabetes mellitus 

15. Cochlear implant recipients (pre/post implant) 

16. Chronic cerebral spinal fluid leak 

17. Residents of chronic care facilities or wards 

18. Hematopoietic stem cell transplant (HSCT) (recipient)

AND

***Those who are 18 to 64 and meet the specific criteria listed below under the "IPD: Interim Immunization Strategy" are also eligible under the high-risk program***

IPD: Interim Immunization Strategy 

• Elevated IPD in certain areas: Several northern Ontario PHUs continue to report elevated levels of invasive pneumococcal disease activity.
• Interim strategy to address increased risk: To support local outbreak prevention and response efforts, northern public health units experiencing increased IPD activity may implement an interim immunization strategy to support northern and Indigenous communities identified as being at increased risk.
  • TBDHU is implementing this strategy
• Expanded eligibility for 18-64 years: Under this interim immunization strategy, TBDHU will expand immunization based on our local epidemiology and recommend/offer a publicly funded dose of Pneu-C-20 to those:
  • experiencing homeless and those without stable housing (e.g., couch surfing, shelters, encampments)
  • using drugs regularly including alcohol, cocaine or injection drugs

Maintain Low Threshold for Vaccination:

Given the increased rate of IPD in TBDHU:

• 50 years and old: Please maintain a low threshold for providing the pneumococcal vaccine to individuals 50 years and older, if you suspect that they may have a condition on the list, even if they do not have a confirmed diagnosis.

Routine vaccines for children and those 65 and older

• Continue to encourage vaccination under Ontario’s Publicly Funded Schedule for all children when communicating with parents and guardians.

Vaccine Products:

• Pneu-C-15 
  • Children 6 weeks to 4 years of age at low-risk for IPD
• Pneu-C-20 
  • Individuals ≥6 weeks to 64 years of age at high-risk for IPD
• Pneu-C-21 
  • Has replaced Pneu-P-20 for older adults 65 plus
  • Broader protection against invasive pneumococcal disease (IPD) is expected compared to the Pneu-C-20 vaccine for this age group.
  • Re-vaccination is not part of the product transition to Pneu-C-21 vaccine (i.e., if a dose of publicly funded pneumococcal vaccine was previously received, re-vaccination with publicly funded Pneu-C-21 vaccine is not part of eligibility).

Vaccine Orders:

• Order form

Patient Resources:

• Patient factsheet (en français).

Other Resources:

• Canadian Immunization Guide: Pneumococcal vaccines (en francais)
• Public Health Agency of Canada Pneumococcal Disease Factsheet (en français).

Public Health Guidance

Infectious Disease Protocol: Appendix 1 (May, 2022) includes:

• Case Definition/Outbreak Definition
• Clinical Information
• Laboratory Evidence
• Case and Contact Management
• Outbreak Management
• Prevention and Control Measures
• Disease Characteristics

Laboratory Services – Public Health Ontario (PHO)

• Streptococcus pneumoniae – Real-time PCR
• Streptococcus pneumoniae – Serotyping

Public Health Ontario – Additional Resources

• Public Health Ontario

Additional Resources

• Government of Canada

Questions

• Vaccine: Contact Vaccine Preventable Diseases at 807-625-5908; toll-free at 1-888-294-6630.
• Invasive Pneumococcal Disease: Contact Infectious Diseases at 807-625-8318; toll-free at 1-888-294-6630 (ext. 8318)