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As One of Canada's Top Killers, Why Isn't Pneumonia Taken More As One Of Canada’s Top Killers, Why Isn’t Pneumonia Taken More Seriously? $ $ $ March, 2019 Table of Contents 02 04 06 About the Authors and Executive National Institute Reviewers Summary on Ageing 10 24 27 Background Dierent Types Who Should and Context of Pneumococcal Get Vaccinated? Vaccines 32 41 44 Vaccination Policies Improving What Are Our and Their Outcomes Vaccination Governments Doing in Canada Rates To Improve Vaccination Rates? 45 50 56 Not Enough Data Evidence- References Exists To Fully Informed Understand Recommendations Pneumococcal Disease In Canada As One of Canada’s Top Killers, Why Isn’t Pneumonia Taken More Seriously? About the National Institute on Ageing The National Institute on Ageing federal and global partnerships with (NIA) is a policy and research centre other academic centres, and based at Ryerson University in ageing-related organizations. Toronto. The NIA is dedicated to enhancing successful ageing across The NIA further serves as the the life course. It is unique in its academic home for the National mandate to consider ageing issues Seniors Strategy (NSS), an evolving from a broad range of important evidence-based policy document perspectives, including those of co-authored by a group of leading nancial, physical, psychological, researchers, policy experts and and social wellness. stakeholder organizations from across Canada and rst published in The NIA is also focused on leading October 2015. The NSS outlines four cross-disciplinary research to better pillars that guide the NIA's work to understand the issues that can lead advance knowledge and inform to the development of policies through evidence-based evidence-informed actionable research around ageing in Canada insights that can meaningfully that include Independent, contribute towards shaping the Productive and Engaged Citizens; innovative policies, practices and Healthy and Active Lives; Care Closer products that will be needed to to Home; and Support for Caregivers. address the multiple challenges and opportunities presented by Canada’s coming of age. The NIA is committed to providing national leadership in promoting a collaborative approach that also seeks to continually establish municipal, provincial, About the National Institute on Ageing 02 National Institute on Ageing Immunization Series Suggested Citation: National Institute on Ageing. (2019). As One of Canada’s Top Killers, Why Isn’t Pneumonia Taken More Seriously? Toronto, ON: National Institute on Ageing White Paper. Mailing Address: National Institute on Ageing Ted Rogers School of Management 350 Victoria St. Toronto, Ontario M5B 2K3 Canada As One of Canada’s Top Killers, Why Isn’t Pneumonia Taken More Seriously? In 2018, the NIA began looking at policy and decision-makers can adult immunizations as a part of its better understand and promote ‘Healthy and Active Lives’ pillar of policies and activities that better work, encouraging education and support wellness, prevention, and support so that Canadians, as well as overall healthy ageing. NATIONAL SENIORS STRATEGY INDEPENDENT, HEALTHY CARE CLOSER SUPPORT FOR PRODUCTIVE & AND ACTIVE TO HOME CAREGIVERS ENGAGED CITIZENS LIVES Provides Enables older Supports Canadians person-centered, Acknowledges and Canadians to remain to lead healthy and high quality, support the family independent, active lives for as integrated care as and friends of older productive and long as possible. close to home as Canadians who engaged members possible by providers provide unpaid care of our communities. who have the for their loved ones. knowledge and skills to care for them. THE FOUR PILLARS SUPPORTING A NATIONAL SENIORS STRATEGY ACCESS EQUITY CHOICE VALUE QUALITY THE FIVE FUNDAMENTAL PRINCIPLES UNDERLYING A NATIONAL SENIORS STRATEGY About the National Institute on Ageing 03 As One of Canada’s Top Killers, Why Isn’t Pneumonia Taken More Seriously? Authors and Reviewers The background research for this David N Fisman, MD, MPH, FRCPC report was undertaken by Julie Professor and Chair, Division of Dunning (NIA Policy Analyst) and Dr. Epidemiology Shara Nauth (NIA Junior Research Dalla Lana School of Public Health Fellow). It was written by Dr. Samir University of Toronto Sinha (Director of Geriatrics, Sinai Health System and University Health Dawn Bowdish, PhD Network; Associate Professor of M.G. DeGroote Institute for Infectious Medicine, Family and Community Disease Research Medicine, Health Policy, McMaster Immunology Research Management and Evaluation, Centre, McMaster University University of Toronto; NIA Director of Health Policy Research), Julie Dr. Natasha S. Crowcroft, Dunning (NIA Policy Analyst), Ivy MD(Cantab), MSc, MRCP, FFPH Wong (NIA Policy Director), Michael Chief, Applied Immunization Research Nicin (NIA Executive Director), and and Evaluation, Public Health Ontario Dr. Shara Nauth (NIA Junior Professor, Laboratory Medicine and Research Fellow). This report was Pathobiology and Dalla Lana School of edited by Arianne Persaud (NIA Public Health, University of Toronto Manager of Advocacy, Government Adjunct Scientist, ICES Relations and Stakeholders). Allison McGeer, MD, FRCPC We gratefully acknowledge our Medical Director, Infection Prevention contributors who provided much and Control, Sinai Health System guidance on the content and nal Professor, Laboratory Medicine and recommendations. Any opinions or Pathobiology, Dalla Lana School of errors reected in this report are of Public Health, University of Toronto the NIA alone: Authors and Reviewers 04 As One of Canada’s Top Killers, Why Isn’t Pneumonia Taken More Seriously? Disclaimer: The NIA has developed Funding for this report was this document to provide a summary generously provided by Pzer Canada of general information about the in the form of an unrestricted burden of pneumococcal disease and educational grant. All of the research, the benet of the pneumococcal writing and recommendations herein vaccine, as well as provide have been independently produced evidence-informed recommendations by the NIA on the basis of sound to support uptake of the evidence. pneumococcal vaccine. The NIA’s work is guided by the current evidence. This document can be reproduced without permission for non-commercial purposes, provided that the NIA is acknowledged. Authors and Reviewers 05 As One of Canada’s Top Killers, Why Isn’t Pneumonia Taken More Seriously? Executive Summary For over a decade, the Public Health breathing, coughing, fever, fatigue, Agency of Canada (PHAC) set an 80% nausea and vomiting, chest pain, target vaccination coverage rate changes in heartbeat, confusion or with the pneumococcal vaccine for delirium, and diarrhea.4 those over the age of 651 – however, estimates suggest that as of 2016, Many Canadians only 42% of Canadians had received their pneumococcal vaccination.2 At believe that they the same time the target vaccination are up-to-date coverage rate for children under the age of two was set at 95%1, and on their recommended research shows children are doing vaccinations, the reality is much better with conservative estimates suggesting 80% of quite different. In 2016, Canadian children have been 88% of Canadians vaccinated against pneumococcal disease.3 While many Canadians responding to a PHAC believe that they are up-to-date on survey reported that they their recommended vaccinations, the reality is quite dierent. In 2016, were up-to-date on their 88% of Canadians responding to a PHAC survey reported that they were vaccinations, but only 3% up-to-date on their vaccinations, but were found to be actually only 3% were found to be actually up-to-date according to Canadian up-to-date according to recommended standards.2 Canadian recommended 2 Pneumonia represents only one standards possible manifestation of It can be serious and sometimes fatal – pneumococcal disease or infection. especially for older adults, infants, and Pneumonia is a common lung young children.5 Pneumonia can be infection that can have many caused by bacteria, viruses, and more symptoms including diculty rarely by fungal infections.6 Executive Summary 06 As One of Canada’s Top Killers, Why Isn’t Pneumonia Taken More Seriously? The most common cause of bacterial Pneumonia is among one pneumonia is a bacteria called Streptococcus pneumoniae.6 S. of the top ten reasons that pneumoniae can lead to a more people went to Emergency serious condition called invasive pneumococcal disease, which is Departments (ED) in when the bacteria enters parts of the Canada, with 135,000 body where it is not typically found.7 This can result in meningitis and pneumonia-related ED bacteremia.7 visits last year.11 The incidence of pneumonia Lack of availability of specic amongst adults is highest with older diagnostic tests means that the true Canadians.8 There are increased rates burden of pneumonia across the of pneumonia in older adults when country is likely underestimated.12 compared to those under age 65, Better ways to test for and determine with residents of long-term care the cause of disease, will allow for homes having even higher rates. 9 better vaccine development but Pneumonia can be a consequence of there is a lack of good data on how inuenza infection. Together with many people are actually vaccinated. inuenza, pneumonia was the 8th In Canada, the reality is that we do leading cause of death in Canada in not actually know how many people 2016 – however, when looking at have been vaccinated. individuals 85-89 years of age it is the 7th leading cause of death and Vaccination is an eective way to at 90
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