IMPACT Project Protocol: Enhanced Population-based Core Surveillance of Meningococcal Invasive Infections at Participating Centers Across Canada
Conditions: Invasive Meningococcal Disease
Sponsor: Canadian Paediatric Society

 
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IMPACT Project Protocol: Enhanced Population-based Core 
Surveillance of Meningococcal Invasive Infections at Participating 
Centers Across Canada  
 
 
Co-Principal  
Investigators: 
N. Le Saux, Children’s Hospital of Eastern Ontario, Ottawa 
 
 
 
 
J. Bettinger, BC’s Children’s Hospital, Vancouver  
 
 
 
 
 
 
 
 
 
 
Sponsors: 
Canadian Paediatric Society (CPS) (M. Davis, Executive Director) 
 
 
Sanofi Pasteur, Toronto, Ontario, September 1, 2003 to April 30,  
 
2012 (data collection January 1, 2002 – December 31, 2011) 
 
 
Novartis Vaccines, Montreal, Quebec, January 1, 2012 – December 
31, 2015 
 
 
 Pfizer Canada, Inc., Montreal, Quebec, January 1, 2016 – June 30 
2023 (data collection January 1, 2016-December 31, 2022) 
 
GSK Biologicals, GSK Belgium, January 1, 2019- June 2021 (data 
collection January 1, 2019-December 31, 2020) 
  
 
 
 
Funding type: 
Research grant to CPS, as coordinator of the IMPACT network 
 
 
 
 
 
 
 
 
 

 
2 
Date:  
October 29, 2020  
 
 
 
Participating Centers and Co-investigators (Phase 3 Site Investigators in bold): 
 
K. Top, S. Halperin, IWK Health Centre, Halifax, S McNeil (Adult ID) 
 
R Thibeault, P. Déry1, Centre Mère-Enfant Soleil de Québec (CHUL), Quebec City; G 
De Serres (Laval University and Quebec Institute of Public Health); P de Wals 
(Department of Social and Preventive Medicine, Laval University) 
 
S. Morris, V. Waters, L. Ford-Jones2 D. Tran3, The Hospital for Sick Children, Toronto 
A McGeer, A Simor (Adult ID/Microbiology); I Kitai, J Tollkin (Community Pediatrics); 
K Green (Infection Control); Public Health: B Yaffe (Toronto), L Van Horne, D 
McKeown (Peel), B Nosal (Halton), G Pasut (Simcoe), H Kassam (York), R Kyle 
(Durham), C D’Cunha, E Chan, C Kwawa; F Jamieson, S Richardson (Microbiology) 
 
J. Embree, B. Law4, Winnipeg Children’s Hospital, Winnipeg 
P Vancaeseele (Winnipeg Regional Health Authority); C Beaudoin (Manitoba Health) 
 
J. Bettinger, M. Sadarangani, D. Scheifele5, BC’s Children’s Hospital, Vancouver 
P Daly, M Murti (Public Health); W Bowie (Adult ID) 
 
N. Le Saux, Children’s Hospital of Eastern Ontario, Ottawa 
V Roth (Adult ID); P Arnold (CI-Public Health), Ottawa 
 
T. Jadavji, Alberta Children’s Hospital, Calgary 
D Gregson (Adult Microbiology); J MacDonald (Public Health) 
 
J. Papenburg, M. LeLefebvre6, D. Moore7, Montreal Children’s Hospital, Montreal 
 
C. Foo, N. Bridger8, R. Morris9, Janeway Children’s Health and Rehabilitation Centre, 
St. John’s; F Stratton (Public Health) 
 
M. Lebel, CHU Sainte-Justine, Montreal 
 
W. Vaudry, Stollery Children’s Hospital, Edmonton 
G Taylor (Adult ID); M Johnson (Public Health) 
 
B. Tan, Royal University Hospital, Saskatoon 
 
J. Pernica, McMaster Children’s Hospital, Hamilton 
 
R. Tsang, National Microbiology Laboratory, Winnipeg 
 
 

 
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1 to Jan. 2013, 2to June 2007, 3to Dec. 2016,  4to June 2005, 5to June 2017, 6to Dec 2017 
7to July 2016, 8to Dec 2019, 9to Jan. 2012  
 
IMPACT Project Protocol: Enhanced Population-based Core 
Surveillance of Meningococcal Invasive Infections at Participating 
Centers Across Canada 
 
 
1.         PROJECT SUMMARY 
 
Active metropolitan area surveillance for hospital admissions related to invasive 
infection with Neisseria meningitidis will be conducted at the 13 centers in the IMPACT 
network in collaboration with Public Health officials, local infection specialists (many of 
whom are members of the Public Health Agency/Canadian Institutes of Health Research 
Canadian Immunization Research Network (CIRN)) and infection control practitioners 
during the interval from January 1, 2016 to December 31, 2022. Meningococcal 
surveillance expanded  to a new center in Hamilton, Ontario (center 13) on January 1, 
2019. The objectives are 3-fold, including: 
• description of affected children and adults and the nature and outcome of the 
infection episodes 
• incidence rate determination in defined populations, by age, serogroup and study year 
• 
detailed study of the organisms recovered from cases 
 
The nurse monitor at each center will seek to identify meningococcal cases admitted 
to the IMPACT hospital through regular contacts with the bacteriology laboratory, 
infection control practitioners and staff of the wards and intensive care unit.  Both local 
and referred cases will be reported.  In addition, in collaboration with CIRN monitors 
where they are present, IMPACT monitors will identify meningococcal infections 
affecting children and adults at other acute care hospitals within defined population areas 
surrounding the IMPACT center, using expedient case-finding strategies.  Completeness 
of case-finding will be audited bi-annually by contacting local Public Health Units, 
liaising with microbiologists and/or infection control practitioners at all hospitals in the 

 
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specific catchment areas and searching health records at local hospitals for relevant 
discharge codes.  The case definition will be based on identification of N. meningitidis in 
a normally sterile body fluid or site such as blood or cerebrospinal fluid (CSF) by culture 
or PCR test.  Case information will be entered electronically on the standardized case 
report form.  No personal identifiers will be included in these reports, which will be 
assigned an individual code number upon data entry. 
 
2.  
BACKGROUND 
2A.  
2002-2016 Summary 
Since 2002, 12 IMPACT centers have been searching their defined catchment 
populations for cases in order to calculate the annual incidence rate for invasive 
meningococcal infection among children and adults.  The defined population areas 
encompassed over 17 million adults and children, just over 50% of the Canadian 
population. With 12 IMPACT centers, the network encountered approximately 100 cases 
per year, although local outbreak activity and previous and new immunization programs 
influenced this.  The case totals amounted to half of the national total.  The population 
data was census-based.  Analyses addressed the effects of age, meningococcal serogroup 
and impact of new immunization programs on incidence rates. 
 
 
Hospital microbiology labs forwarded all invasive meningococcal isolates to the 
provincial laboratories as per local arrangements.  The isolates were then shipped to the 
National Microbiology Laboratory where they were typed in detail.  Isolates were 
matched with the case and identified with an IMPACT code number.  Test results were 
collated at the IMPACT data center. 
 
 
This study has assembled the largest and most complete picture of meningococcal 
disease to date in Canada, just in time to measure the effects of group C conjugate 
vaccine programs, assess the burden of disease associated with other serogroups, for 
which multi-valent conjugate vaccines are now available and predict and monitor the 
effects of new serogroup B vaccines as they become available. 
 

 
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2B. 
Meningococcal Invasive Infections 
 
Meningococci rank second in Canada among bacteria causing life-threatening 
infection in children, adolescents and adults. With the initiation of group C immunization 
programs overall incidence has declined from 0.6 per 100,000 to <0.05[1].  Peak 
incidence occurs in children under 1 year of age (at 6.0 per 100,000 per year) but a 
smaller secondary peak is also apparent in the adolescent age group.  Bloodstream 
invasive infections can progress very rapidly, causing shock and microvascular damage, 
with high mortality [2, 3].  Bacteremia can also result in purulent meningitis, septic 
arthritis, serosal space infections etc.  Pneumonia features in some cases, either as the 
portal of entry or a complication of bacteremia.  In previous IMPACT reports of 
meningococcal cases [2, 4, 5], 68% of cases required initial intensive care.  Median 
length of stay in hospital was 8 days (range 1-107 days).  Overall mortality averaged 
9.3% [4].  Sequelae at discharge including deafness, amputations and neurological 
deficits occurred in about 18% of cases, with highest rates following group C disease [2, 
5]. 
 
Prevention of meningococcal infections using vaccines is complicated by the 
existence of multiple serogroups, which are immunologically unrelated.  Serogrouping is 
based on the polysaccharide capsular material that coats the bacteria and impedes uptake 
by phagocytic cells.  Antibodies directed against the capsular polysaccharide afford 
protection against the particular serogroup but do not cross-react with other serogroups.  
Purified polysaccharides are the basis of first generation vaccines, which typically 
contain antigens of serogroups A, C, Y and W.  The polysaccharide-based meningococcal 
vaccines are poorly immunogenic in young children [6] (the age group at highest risk of 
infection) and protect for only a few years, for lack of immunologic memory [7].  Thus 
their use has been limited to special circumstances, such as control of outbreaks and 
protection of individuals at increased risk [8]. 
 
Since 2001 a second generation of meningococcal vaccines was introduced in 
which capsular polysaccharide is chemically linked to a carrier protein such as tetanus 

 
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toxoid.  These conjugate vaccines are able to elicit protective responses from 2 months of 
age and establish immunologic memory, which lasts longer than that provided by the 
polysaccharide-based vaccines.    Their safety and effectiveness were demonstrated in a 
nationwide program in the United Kingdom.   Serogroup C conjugate vaccines are 
recommended for routine administration to infants and children and have been supplied 
as part of the public program in all provinces since 2005. 
 
Conjugate vaccines targeting all four of the preventable meningococcal 
serogroups have been developed and licensed in Canada.  They include serogroups A, C, 
Y and W and since 2011,  have been supplied as part of the public program for 
adolescents in 6 provinces [9].  Group Y meningococci increased in importance during 
the 1990s  in Canada and the USA to account for one-third of cases in the USA [10] and 
about 12%-18% in Canada [4, 11, 12].  Highest rates occur in adolescents and young 
adults [13]; however one third of serogroups Y cases are in adults > 60 years of age [5].  
Meningococci belonging to serogroup W typically cause sporadic cases but have the 
potential to cause outbreaks [14].  Serogroup A strains have not been endemic in Canada 
for several decades but cause epidemic disease in other parts of the world (e.g. sub-
Saharan Africa).  Protection is desirable for travelers to endemic areas [15]  and residents 
therein.  Population immunity may help to prevent re-introduction of group A strains to 
Canada.  Finally, potential shifts in serogroup predominance due to programs aimed at 
preventing group C disease should be considered. 
 
The capsule of group B strains is not immunogenic and until recently no licensed 
vaccine was available.  This was an unfortunate gap because group B strains cause a 
substantial portion of infections in young children [10].  A newly developed third 
generation of vaccines containing surface-exposed proteins to protect against multiple 
strains of serogroup B was recently approved in Canada. One of the vaccines has been 
used epidemic/outbreak control in mass immunization programs in regions of Quebec 
and at one university campus in Nova Scotia. Much like the conjugate pneumococcal 
vaccines [16, 17], these serogroup B vaccines will not provide protection against all 
serogroup B strains that cause invasive disease.  Thus continued surveillance will be 

 
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particularly important to monitor epidemiologic shifts in invasive meningococcal disease 
as these vaccines are used in the population. 
 
Most cases of meningococcal infection occur in previously healthy individuals.  
The rate or severity of infection is increased among persons with complement disorders 
[18], other immunodeficiencies and asplenia [8].  Among healthy individuals, the risk of 
infection is increased among those exposed to a recent case, those newly housed in 
crowded groupings (military recruits, university dormitories, homeless shelters) [19], 
smokers (especially in crowded social settings) and possibly in those with recent 
influenza or other viral respiratory infection [10]. 
 
 
It is particularly timely to continue enhanced surveillance of meningococcal 
infections in children and adults.  Robust surveillance systems are necessary in order to 
determine the impact of new vaccination strategies for targeted or universal prevention 
programs.  Just as the use of conjugated pneumococcal vaccine in infants has caused a 
decrease in the incidence of invasive disease in adults [20], the implications of such 
programs for meningococcal disease in the entire population are critical. Data from 2002-
2013 will provide baseline information for most provinces, against which the benefits of 
new immunization programs using group B vaccines and expansion of quadrivalent 
vaccine programs can be measured.  The relative importance of serogroup B strains not 
included in the vaccine will be of interest, particularly any shifts upward in specific 
strains or changes in the clinical presentation as serogroup B disease is curbed. 
Additionally, the effects of group C and quadrivalent conjugate vaccines can continue to 
be measured and monitored.  Decisions to routinely use multivalent vaccines will require 
detailed information about group-specific risk of disease, complications and deaths.  This 
study will continue to be a principal source of such information and will form a 
foundation upon which additional research (such as health economic research, health 
policy research, etc.) can be undertaken.  
 
3. 
STUDY PLAN  
 
The study plan has 3 related elements: 

 
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• case surveillance 
• incidence rate determination 
• isolate studies 
3A. 
Case surveillance 
 
 
Active surveillance for invasive meningococcal disease (IMD) will continue at 13 
participating IMPACT centers [21, 22], which admit over 75,000 children annually, in 
the age group 0-16 years.    Centers account for over 90% of Canada’s tertiary care 
pediatric beds.    Each IMPACT center employs a nurse monitor to seek out and report 
specified target conditions.  The current targets include a range of post-immunization 
adverse events, acute flaccid paralysis, invasive pneumococcal, meningococcal and H. 
influenzae infections and admissions with pertussis, varicella, zoster or rotavirus 
infection.  Monitors work part or full time depending on the size of the center, under the 
supervision of a volunteer investigator.  The latter are pediatric infectious disease 
specialists. 
 
 
Case-finding at IMPACT centers is based on frequent contacts with the hospital 
microbiology laboratory, infection control practitioners, staff of the wards and intensive 
care unit and local public health.  Both local and referred cases are reported. 
 
 
Case finding in surrounding areas includes all pediatric and adult cases arising 
from defined populations.  Surveillance will encompass all acute care hospitals within the 
specific area generally corresponding with Statistics Canada Metropolitan census areas.  
Situationally appropriate strategies will be used to facilitate surveillance. Collaboration 
with the CIRN Severe Outcome Surveillance Network (CIRN-SOS) will enhance 
involvement of adult infectious disease specialists located at the adult care facilities in the 
IMPACT cities.  Where microbiology services are regionally centralized, close liaison 
with the laboratory will suffice to detect cases.  Where a close working relationship is 
possible between regional public health officials and the IMPACT team, monitors will 
arrange to be advised of new cases as public health officials receive the required case 
notifications from regional hospitals and physicians.  Where few other hospitals exist 

 
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within a specific area, monitors will liaise with laboratory and/or infection control staff at 
those hospitals to identify new cases.  Various combinations of such methods may be 
used to best suit local circumstances.  The objective for each locale is to ascertain as 
many cases in real time as possible with the remainder being identified by periodic record 
reviews.  
 
 
At all healthcare sites, approval for enhanced surveillance of invasive 
meningococcal disease will be obtained and renewed as required.  With approval, the 
nurse monitor will review the patient chart to complete the case report form.  Data will be 
collected in a confidential fashion without case identification.   
 
 
Completeness of case finding will be audited every 6 months by searching 
microbiology records and health records (using relevant discharge codes) at each area 
institution and by cross-checking cases with local Public Health officials. The complete 
list of ICD10 codes is appended.  
 
 
The surveillance case definition will include each of the following elements: 
- 
Neisseria meningitidis isolated or detected by PCR from a normally sterile body 
site or fluid, such as blood, CSF, joint fluid, pleural, peritoneal, pericardial fluid 
or tissue biopsy.   
- 
persons of all ages 
- 
with onset between January 1, 2002 and December 31, 2022 
- 
For Hamilton between January 1, 2019 and December 31, 2022 
 
Patients who are not eligible for inclusion in the surveillance of cases: 
- 
diagnosis based only on clinical signs, gram stain, or antigen test 
- 
meningococci isolated only from respiratory tract, including conjunctiva, sinuses, 
middle ear/mastoid, throat, peritonsillar abscess, cervical lymph node, tracheal 
aspirate, bronchial lavage etc.  (While such isolates could be linked with invasive 
infection they do not define it adequately.) 
 

 
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Monitors will complete a standardized case report electronically.  Information 
to be gathered will include the following subject to availability in the health record: 
 
- 
demographic data: 
birthdate, sex, ethnic origin, partial postal code (first 3 
digits) of community of residence  
- 
health history: 
general state of health, any chronic condition (including 
smoking, alcoholism, IV non-prescription drug use), any 
immune disorder 
 
 
previous meningococcal or other invasive infection 
 
 
previous meningococcal vaccination (product, date) 
- 
current illness: 
dates of onset, admission to hospital 
 
 
extent, severity and complications of infection, level of care 
required; duration of stay; outcome 
- 
isolate data:   
source, susceptibility to antibiotics, serogroup (or PCR-
based data where available, if culture negative) 
- 
risk factors identified: complement disorder, other immunocompromise(including 
HIV/AIDS), recent contact with a meningococcal case, 
demographic factors, recent foreign travel (e.g. to Africa, 
Saudi Arabia), or group living arrangement (college 
dormitory or residence, barracks or homeless shelter), 
teaching profession 
 
 
No personal identifiers will be collected, such as name, initials or address.  
Community of residence will be identified from the first 3 digits of the postal code.  For 
linkage purposes, a local inventory number will be assigned to each case.  This number 
can be used by the monitor to link the case report form with the person’s hospital 
registration number.  A separate record with the local inventory number and the hospital 
registration number is kept at each IMPACT center in a locked, secure file.  This 
information does not leave the IMPACT center.   Subjects will not be contacted to 
supply missing information.  The family physician or health department may be 
contacted to obtain pertinent immunization information, per IMPACT routine. 

 
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Patient data will be entered electronically on the case report form.  Completed 
electronic case reports will be accessed by the IMPACT data center in Vancouver where 
they will be scrutinized for completeness.  Any queries will be resolved with the monitor.  
Data security measures include code-limited access to the main database, with frequent 
tape backups of the main and working databases.    A tally of reports received will be 
issued at the end of each month, indicating by center the number of cases reported that 
month and during the year to date. 
 
Data submitted to the data center is encrypted and stored on a physically secure, non-
public SQL Server database located at the Child and Family Research Institute in 
Vancouver.  The data is entered through the web-based Daciforms application software 
based on user account role verification.  All user accounts have specific rights/restrictions 
clearly stated within the system, including read/write ability, scope accessibility (by 
centre and individual data forms), data querying, and data extraction rights.  All users' 
passwords are encrypted within the database and all data traffic between the users and the 
database is encrypted (SSL protocol). 
 
 
The database will be reviewed in depth at least annually, usually prior to the 
annual meeting of Investigators. 
 
3B. 
Incidence Rate Determinations 
 
 
Age-group specific, serogroup-specific and regional incidence rate determinations 
will be made.  Completeness of the case totals (numerators) will be verified by audit of 
laboratory and health records data, as above.  Duplicate cases will be removed.  Audits 
will extend to any other acute care hospitals in the defined areas, to identify eligible 
cases.  Monitors will complete standard case reports for such cases, to provide a complete 
picture of the disease burden locally.  Where appropriate, audits will extend to selected 
hospitals just outside the defined areas, to ascertain whether any individuals from the 
defined areas are admitted there for illness care.   

 
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The defined areas will correspond with established census tracts, permitting use of 
population census data.  Defined catchments have been determined  for 13 IMPACT 
centers.  Current population data will be used, using best estimates for inter-census years, 
to be obtained from Statistics Canada or local health authorities. 
 
 
3C. 
Studies of Case Isolates 
 
 
Every reasonable effort will be made to ensure that an isolate is saved from each 
eligible case, including those diagnosed at a referring hospital or other local hospital, for 
special studies. 
 
If the isolate has been identified at an IMPACT hospital, their microbiology 
laboratory will forward the isolate to the provincial laboratory as per the established 
protocols. If the isolate has been identified at a non-IMPACT hospital or laboratory, the 
isolate will be sent to the provincial laboratory as per the expected protocol for notifiable 
infections.  Monitors will encourage or confirm compliance on a case by case basis. 
 
The IMPACT data centre communicates with the National Microbiology 
Laboratory in Winnipeg on reported cases, at intervals throughout the year, once the data 
has been entered electronically by the centers.  In order to maintain confidentiality, 
information will include only date of birth, date of culture, province, (and hospital where 
the isolate was recovered), source of the specimen, and the assigned IMPACT number.  
Dr. Tsang at the National Laboratory will match the isolates received with our case list 
and label the isolates with the IMPACT numbers. 
 
 
At the National Laboratory isolates will be subjected to serotyping and 
serosubtyping on the basis of their major outer membrane proteins, multilocus sequence 
typing (MLST), the Meningococcal Antigen Typing System (MATS), and nucleotide 
sequencing of antigen genes.  PCR-based serogrouping will be attempted for isolates that 
are non-groupable by standard serologic means [23].  As test results are completed they 
will be reported electronically to the IMPACT data center and collated with case reports.  

 
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Isolates will be identified only by their IMPACT code number.  Isolates will be kept in 
storage as the IMPACT collection, for future studies.  Isolates may be used to facilitate 
detailed studies of meningococcal B in anticipation of new vaccines to prevent serogroup 
B infections.  Isolates or details about the isolates subtypes may be shared upon 
appropriate request to the IMPACT executive.   
 
 
4. 
LOGISTICS 
 
 
With the current roster of 13 centers and defined population areas exceeding 17 
million persons, the projected case total in 2016 is 80 to 100 cases per year.  This 
projection is based on the incidence rate of 0.45 per 100,000 observed in recent years 
across Canada [4, 24].  Case totals will be influenced by variability in sporadic disease 
activity, and outbreaks. New immunization programs using group C conjugate have 
reduced serogroup C case totals [4, 25]. 
 
Monitors will be provided with a time allocation budget based on the expected 
number of cases in adults and children encountered annually at each center with an 
increase provided to those centers where the majority of cases occur outside of the 
IMPACT hospital.  Allocations will encompass all activities related to the study. 
 
 
The expected distribution of cases per year in children and adults in 2016 is 
summarized as follows:  
 
 
Halifax 
2-5 
 
Vancouver 
14-17  
Ottawa  
5-7 
 
Quebec 
14-17  
St. John’s 
2 – 4  
Calgary 
4-5 
 
Toronto 
15-20  
Montreal 
15-20  
Edmonton 
6-8 
 
Winnipeg 
3-5 
 
Saskatoon 
2 – 4  
Hamilton 
4-6 
 
 
 
Budget allocations recognize that some of the work involved in this project is 
independent of caseload, including annual REB renewals and periodic amendments, 
monitor orientation, ascertainment audits etc.  Centers are given equal time allowances 

 
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for such activities.  Caseload dependent activities are based on the higher figures in the 
above ranges. 
 
 
The project will assemble 20 years of case information (2002-2022).  An annual 
report for the preceding year on surveillance activities will be written at the end of the 
second quarter that will include surveillance through December 31, of each year.  
Surveillance will conclude on December 31, 2022 but wrap-up and analysis activities will 
continue to June 30, 2023. 
 
5. 
ANALYSIS PLAN 
 
 
All of the eligible cases seen at the 13 centers will be combined for a case series 
analysis, reflecting the total experience of centers with local and referred cases.  This 
analysis will consider the age distribution of infections (overall and by serogroup); 
presenting syndromes; length of hospital stay and utilization of intensive care facilities; 
case fatality rate and risk factors for fatal outcome; and major sequelae of infection.  
 
 
Annual population-based analyses will be made based on populations at the 13 
centers.  Analyses will include: age-specific attack rates; serogroup-specific attack rates; 
regional incidence rates; estimated cumulative risk of meningococcal infection by 
serogroup; case-fatality rates by age, syndrome and serogroup; decline in rates of group B 
disease in provinces with new immunization programs; and difference in rates of group B 
and other groups in provinces with and without immunization programs or with 
differently structured programs.  Disease burden will be described in detail, similar to the 
case series.  Comparison with national notifiable diseases data will be made when 
notifiable disease data are available. 
 
 
Of interest regarding the infecting organisms will be an analysis of diversity 
within the major serogroups, looking particularly for evidence of dominance of particular 
strain characteristics.  MATS results will be summarized, if available.  Population-based 

 
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data will lend itself to an analysis of the severity of disease associated with each 
serogroup.   
 
 
6. 
ETHICAL CONSIDERATIONS 
 
 
This project is being done in collaboration with Medical Officers of Health in all 
jurisdictions. Meningococcal infections are reportable communicable diseases in Canada. 
This obligation is met by the infection control practitioner or laboratory staff of the 
participating hospitals reporting to Public Health authorities in all jurisdictions and will 
not be duplicated by IMPACT monitors.  Similarly, the forwarding of meningococcal 
isolates to the provincial and national laboratories is standard public health practice, to 
which hospitals are expected to comply.   
 
 
The IMPACT project will collect more detailed information about cases than 
accompanies communicable disease reports (enhanced surveillance).  IMPACT staff and 
procedures will protect the confidentiality of personal information.  Case report forms 
will not contain personal data, apart from birthdate (necessary for calculation of age 
incidence, vaccine failures and linkage of isolate information) and partial postal code 
(necessary for distinguishing cases from defined census areas).  The latter will be limited 
to the first 3 digits, to preserve anonymity. 
 
 
Case audits at all hospitals will observe the same principles of ethics and 
safeguards.  With approval of local ethics boards, contact will be made with the health 
records supervisor, requesting a search for eligible cases (specified discharge codes, time 
period, area of residence).  If additional cases are identified, the monitor will seek 
permission to review the medical record and complete a case report, as above. 
 
 
Isolates will be linked with IMPACT cases only after they have made their way 
through routine channels to the National Microbiology Laboratory in Winnipeg, where 
the assigned IMPACT code number will be added.  The IMPACT project will fund more 

 
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detailed characterizations of isolates than is routinely performed.  Results will be 
analyzed and reported in collaboration with the laboratory director, Dr. Raymond Tsang. 
 
 
 Additional funding for related projects may be provided by other industry 
partners or government agencies.  All industry and government partners providing 
funding will be provided with summaries of interim data analyses, final reports and 
completed manuscripts from data generated by the project.   
 
 
7. 
FUTURE PLANS 
The surveillance network provides a platform for additional research studies, such 
as past collaborations to examine the long-term morbidity of subjects who survive 
invasive meningococcal disease or to further characterized the strains circulating in 
Canada.  Other future collaborations with industry partners and/or public health are also 
envisioned. 
 

 
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8. 
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18 
16. 
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Invasive pneumococcal disease in children 5 years after conjugate vaccine 
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57(6): p. 144-8. 
18. 
Ellison, R.T., 3rd, et al., Prevalence of congenital or acquired complement 
deficiency in patients with sporadic meningocococcal disease. N Engl J Med, 
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Clin Infect Dis, 2001. 33(5): p. 737-9. 
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Whitney, C.G., et al., Decline in invasive pneumococcal disease after the 
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348(18): p. 1737-46. 
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Scheifele , D.W., IMPACT after 17 years: lessons learned about successful 
networking. Paediatr Child Health, 2009. 14(1): p. 33-35. 
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14(3): p. 213-9. 
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Dolan-Livengood, J.M., et al., Genetic basis for nongroupable Neisseria 
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19 
International Classification of Diseases:  Meningococcal Infection 
 
Syndrome 
 
ICD10 Code 
 
 
 
Meningococcal meningitis 
A39.0 
 
M. encephalitis 
 
A39.8 (G05.0) 
 
Meningococcemia/septicemia 
A39.2 
 
Chronic meningococcemia 
A39.3 
 
M. hemorrhagic adrenal syndrome 
A39.1 
(Meningococcal sepsis with disseminated 
intravascular coagulation, shock) 
 
M. carditis 
 
A39.5 
 
M. optic neuritis 
 
A39.8 (H48.1) 
 
Meningococcal infection NOS 
A39.9 
 
Other meningococcal infection 
 
 
 
Septic arthritis  
A39.8 (M01.0) 
 
 
Post-meningococcal reactive arthritis 
A39.8 (M03.0) 
 
 
 
 
 
 
 
 
 
 
 

 
20 
IMPACT – Defined Population Areas and Case Projections, 2012 
 
Center 
   Children (0-16 yr) 
  Adults 
 Total 
  Predicted Cases per year* 
 
1.    Halifax 
         90,900 
   323,100 
   414,000 
  2.8 
 
2.    Quebec City         128,300 
   525,400 
   653,700 
12.4 
 
3.    Toronto (GTA)   1,607,800 
5,025,600 
6,633,400 
17.2 ** 
 
4.   Winnipeg 
        164,900 
    522,700 
   687,600 
  2.6 
 
5.    Vancouver 
        586,600 
2,097,500 
2,684,100 
11.8 ** 
 
6.    Ottawa 
        202,600 
   679,900 
   882,500 
  6.8 
 
7.    Calgary 
        330,400 
1,042,400 
1,372,800 
  3.0 
 
8.    Montreal CH         392,900 
1,507,600 
1,900,500 
15.2 ** 
 
9.    St. John’s 
          63,600 
   237,300 
   300,900 
  2.8 
 
10.  Montreal SJH   (included above) 
       -   
        - 
     - 
 
11.  Edmonton 
        264,300 
   814,600 
   1,078,900 
  3.8 ** 
 
12.  Saskatoon 
        169,600 
   447,900 
   617,500 
  1.8 
 
13. Hamilton  
       142,900 
   550,000 
   692,900 
2.9 
 
 
TOTALS 
     4,215,300 
14,055,900 
18,271,200 
84.6____ 
 
*   Based on average number of cases at each center from 2006-2010 for centers 1-12.  
For center 13 based on the 2009 incidence of 0.42 per 100,000.  Includes referred 
pediatric cases and adult cases.  Population figures from 2009. 
** Centers where the majority of cases occur outside of the IMPACT center and require 
additional funding to capture all cases.