impact of the introduction of pneumococcal conjugate vaccination on pneumonia in the CORD-Papers-2022-06-02 (Version 1)

Title: Impact of the introduction of pneumococcal conjugate vaccination on pneumonia in The Gambia: population-based surveillance and case-control studies.
Abstract: BACKGROUND Pneumococcal conjugate vaccines (PCVs) are used in many low-income countries but their impact on the incidence of pneumonia is unclear. The Gambia introduced PCV7 in August 2009 and PCV13 in May 2011. We aimed to measure the impact of the introduction of these vaccines on pneumonia incidence. METHODS We did population-based surveillance and case-control studies. The primary endpoint was WHO-defined radiological pneumonia with pulmonary consolidation. Population-based surveillance was for suspected pneumonia in children aged 2-59 months (minimum age 3 months in the case-control study) between May 12 2008 and Dec 31 2015. Surveillance for the impact study was limited to the Basse Health and Demographic Surveillance System (BHDSS) whereas surveillance for the case-control study included both the BHDSS and Fuladu West Health and Demographic Surveillance System. Nurses screened all outpatients and inpatients at all health facilities in the surveillance area using standardised criteria for referral to clinicians in Basse and Bansang. These clinicians recorded clinical findings and applied standardised criteria to identify patients with suspected pneumonia. We compared the incidence of pneumonia during the baseline period (May 12 2008 to May 11 2010) and the PCV13 period (Jan 1 2014 to Dec 31 2015). We also investigated the effectiveness of PCV13 using case-control methods between Sept 12 2011 and Sept 31 2014. Controls were aged 90 days or older and were eligible to have received at least one dose of PCV13; cases had the same eligibility criteria with the addition of having WHO-defined radiological pneumonia. FINDINGS We investigated 18 833 children with clinical pneumonia and identified 2156 cases of radiological pneumonia. Among children aged 2-11 months the incidence of radiological pneumonia fell from 210 cases per 1000 person-years in the baseline period to 162 cases per 1000 person-years (23% decline 95% CI 7-36) in 2014-15. In the 12-23 month age group radiological pneumonia decreased from 153 to 109 cases per 1000 person-years (29% decline 12-42). In children aged 2-4 years incidence fell from 52 to 41 cases per 1000 person-years (22% decline 1-39). Incidence of all clinical pneumonia increased by 4% (-1 to 8) but hospitalised cases declined by 8% (3-13). Pneumococcal pneumonia declined from 29 to 12 cases per 1000 person-years (58% decline 22-77) in children aged 2-11 months and from 26 to 07 cases per 1000 person-years (75% decline 47-88) in children aged 12-23 months. Hypoxic pneumonia fell from 131 to 57 cases per 1000 person-years (57% decline 42-67) in children aged 2-11 months and from 68 to 19 cases per 1000 person-years (72% decline 58-82) in children aged 12-23 months. In the case-control study the best estimate of the effectiveness of three doses of PCV13 against radiological pneumonia was an adjusted odds ratio of 057 (030-108) in children aged 3-11 months and vaccine effectiveness increased with greater numbers of doses (p=0026). The analysis in children aged 12 months and older was underpowered because there were few unvaccinated cases and controls. INTERPRETATION The introduction of PCV in The Gambia was associated with a moderate impact on the incidence of radiological pneumonia a small reduction in cases of hospitalised pneumonia and substantial reductions of pneumococcal and hypoxic pneumonia in young children. Low-income countries that introduce PCV13 with reasonable coverage can expect modest reductions in hospitalised cases of pneumonia and a marked impact on the incidence of severe childhood pneumonia. FUNDING GAVI's Pneumococcal vaccines Accelerated Development and Introduction Plan Bill & Melinda Gates Foundation and UK Medical Research Council.
Published: 2017
Journal: The Lancet. Infectious diseases
DOI: 10.1016/s1473-3099(17)30321-3
DOI_URL: http://doi.org/10.1016/s1473-3099(17)30321-3
Author Name: Mackenzie Grant A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/mackenzie_grant_a
Author Name: Hill Philip C
Author link: https://covid19-data.nist.gov/pid/rest/local/author/hill_philip_c
Author Name: Sahito Shah M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/sahito_shah_m
Author Name: Jeffries David J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/jeffries_david_j
Author Name: Hossain Ilias
Author link: https://covid19-data.nist.gov/pid/rest/local/author/hossain_ilias
Author Name: Bottomley Christian
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Author Name: Uchendu Uchendu
Author link: https://covid19-data.nist.gov/pid/rest/local/author/uchendu_uchendu
Author Name: Ameh David
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Author Name: Ndiaye Malick
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Author Name: Osuorah Chidebereh D
Author link: https://covid19-data.nist.gov/pid/rest/local/author/osuorah_chidebereh_d
Author Name: Adeyemi Oyedeji
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Author Name: Pathirana Jayani
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Author Name: Olatunji Yekini
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Author Name: Abatan Bade
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Author Name: Ahameefula Ebirim
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Author Name: Muhammad Bilquees S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/muhammad_bilquees_s
Author Name: Fombah Augustin E
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Author Name: Saha Debasish
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Author Name: Mackenzie Roslyn
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Author Name: Plumb Ian
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Author Name: Akano Aliu
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Author Name: Ebruke Bernard
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Author Name: Ideh Readon C
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Author Name: Kuti Bankole
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Author Name: Githua Peter
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Author Name: Olutunde Emmanuel
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Author Name: Ofordile Ogochukwu
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Author Name: Green Edward
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Author Name: Usuf Effua
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Author Name: Badji Henry
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Author Name: Ikumapayi Usman N A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/ikumapayi_usman_n_a
Author Name: Manjang Ahmad
Author link: https://covid19-data.nist.gov/pid/rest/local/author/manjang_ahmad
Author Name: Salaudeen Rasheed
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Author Name: Nsekpong E David
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Author Name: Jarju Sheikh
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Author Name: Antonio Martin
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Author Name: Sambou Sana
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Author Name: Ceesay Lamin
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Author Name: Lowe Jallow Yamundow
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Author Name: Sowe Dawda
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Author Name: Jasseh Momodou
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Author Name: Mulholland Kim
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Author Name: Knoll Maria
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Author Name: Levine Orin S
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Author Name: Howie Stephen R
Author link: https://covid19-data.nist.gov/pid/rest/local/author/howie_stephen_r
Author Name: Adegbola Richard A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/adegbola_richard_a
Author Name: Greenwood Brian M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/greenwood_brian_m
Author Name: Corrah Tumani
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license: cc-by
license_url: https://creativecommons.org/licenses/by/4.0/
source_x: Medline
source_x_url: https://www.medline.com/
pubmed_id: 28601421
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/28601421
url: https://doi.org/10.1016/s1473-3099(17)30321-3 https://www.ncbi.nlm.nih.gov/pubmed/28601421/
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