TY - JOUR AU - Kellner, James AU - Ricketson, Leah AU - Demczuk, Walter H.B. AU - Martin, Irene AU - Tyrrell, Gregory AU - Vanderkooi, Otto AU - Mulvey, Michael T1 - Whole-Genome Analysis of Streptococcus pneumoniae Serotype 4 Causing Outbreak of Invasive Pneumococcal Disease, Alberta, Canada T2 - Emerging Infectious Disease journal PY - 2021 VL - 27 IS - 7 SP - 1867 SN - 1080-6059 AB - After the introduction of pneumococcal conjugate vaccines for children, invasive pneumococcal disease caused by Streptococcus pneumoniae serotype 4 declined in all ages in Alberta, Canada, but it has reemerged and spread in adults in Calgary, primarily among persons who are experiencing homelessness or who use illicit drugs. We conducted clinical and molecular analyses to examine the cases and isolates. Whole-genome sequencing analysis indicated relatively high genetic variability of serotype 4 isolates. Phylogenetic analysis identified 1 emergent sequence type (ST) 244 lineage primarily associated within Alberta and nationally distributed clades ST205 and ST695. Isolates from 6 subclades of the ST244 lineage clustered regionally, temporally, and by homeless status. In multivariable logistic regression, factors associated with serotype 4 invasive pneumococcal disease were being male, being <65 years of age, experiencing homelessness, having a diagnosis of pneumonia or empyema, or using illicit drugs. KW - antimicrobial resistance KW - bacteria KW - epidemics KW - homelessness KW - invasive pneumococcal disease KW - outbreaks KW - pneumococcal infections KW - pneumococcal pneumonia KW - respiratory infections KW - streptococci KW - Streptococcus pneumoniae KW - Streptococcus pneumoniae serotype 4 KW - vaccines KW - whole genome sequencing DO - 10.3201/eid2707.204403 UR - https://wwwnc.cdc.gov/eid/article/27/7/20-4403_article ER - End of Reference